E. A. Hedges1, M. Browne2, K. P. Moriarty4, M. V. Raval6, D. H. Rothstein5, D. Wakeman1 1University Of Rochester,Division Of Pediatric Surgery,Rochester, NY, USA 2Lehigh Valley Health Network,Division Of Pediatric Surgery,Allentown, PA, USA 4University Of Massachusetts Medical School-Baystate,Division Of Pediatric Surgery,Springfield, MA, USA 5State University Of New York At Buffalo,Division Of Pediatric Surgery,Buffalo, NY, USA 6Children’s Hospital of Chicago,Division Of Pediatric Surgery,Chicago, IL, USA
Introduction:
North America is in the midst of an opioid epidemic. Deaths from synthetic opioids have risen dramatically in the last several years and have been the focus of significant policy changes in adults. However, the role that children’s surgeons play remains incompletely understood. We conducted a survey of surgeons and proceduralists that care for children to better understand post-procedural opioid prescribing patterns in the pediatric population. We hypothesized that opioid prescribing was common, but varied by patient age.
Methods:
After Institutional Board Review approval, we performed an online survey of 1903 pediatric surgeons and proceduralists (General, Plastic, Urologic, Orthopedic, Otolaryngologic, Ophthalmologic, Cardiac, and Oral Health) who are active members in the American Academy of Pediatrics. The survey inquired about post-procedural prescribing patterns of opioid and non-narcotic pain medications. Perceptions about the magnitude of the opioid epidemic and the role of children’s surgeons were also queried.
Results:
The response rate was 10%. Two-thirds of respondents prescribe opioids themselves. Less than a third of providers utilize a tool to check for prior controlled substance prescriptions routinely. Most respondents utilize acetaminophen (86%) and ibuprofen (80%) post-procedurally > 75% of the time, while gabapentin [25% rarely (<25% of the time), 67% never] and lidocaine transdermal patches (14% rarely, 68% never) are infrequently prescribed. Opioid prescribing increases with age after outpatient and inpatient procedures (see figure). 81.6% of respondents believe the opioid epidemic is a major problem nationally, while only 31.4% believe that pediatric surgical specialists have a major role in helping to control the opioid epidemic.
Conclusion:
Opioid prescribing following surgery in the pediatric population is common. Surgeons are more likely to prescribe opioids post-procedurally as patient get older. While children’s surgeons report the opioid epidemic to be a major problem nationally, fewer believe they have a major role to curb it. Given the magnitude of the opioid epidemic in North America, further efforts are needed to reduce access to opioids in all patient populations.
