N. Denning2, J. Golden2, B. S. Rich1,2, A. M. Lipskar1,2 1Cohen Children’s Medical Center, Northwell Health,Division Of Pediatric Surgery,New Hyde Park, NY, USA 2Zucker School of Medicine at Hofstra/Northwell,Department Of Surgery,Manhasset, NY, USA
Introduction: Non-medical opioid use is a major public health problem. There is little standardization in narcotic prescribing practices for pediatric ambulatory surgery which can result in patients being prescribed large quantities of narcotics. We have evaluated the variability in post-operative pain medication given to pediatric patients following routine ambulatory pediatric surgical procedures.
Methods: Following IRB approval, pediatric patients undergoing umbilical hernia repair, inguinal hernia repair, hydrocelectomy, and orchiopexy from 2/1/2017 to 2/1/2018 at our tertiary care children’s hospital were retrospectively reviewed. Data collected include operation, surgeon, resident or fellow involvement, utilization of pre-operative analgesia, narcotic prescription on discharge, and patient follow up.
Results: Of 329 patients identified, narcotics were prescribed on discharge to 37.4% of patients (66.3% of umbilical hernia repairs, 20.6% of laparoscopic inguinal hernia repairs, and 33.3% of open inguinal hernia repairs (including hydrocelectomies and orchiopexies)). For each procedure, there was large intra and inter-surgeon variability in the number of narcotic doses prescribed. Narcotic prescription ranged from 0 to 33 doses for umbilical hernia repairs, 0 to 24 doses for laparoscopic inguinal repairs, and 0 to 20 doses prescribed for open inguinal repairs, hydrocele repair, and orchiopexy. Pediatric surgical fellows were less likely to discharge a patient with a narcotic prescription than surgical resident prescribers (p<0.05). Additionally, surgical residents were more likely to prescribe more than twelve doses of narcotics than pediatric surgical fellows (p <0.01). Increasing patient age was associated with an increased likelihood of narcotic prescription (p<0.01). There were two phone calls and two clinic visits for pain control issues with equal numbers for those with and without narcotic prescriptions.
Conclusion: There is significant variation in narcotic prescribing practices after pediatric surgical procedures; increased awareness may help minimize this variability and reduce overprescribing. Training level has an impact on the frequency and quantity of narcotics prescribed.
