E. L. Kalbfell1, R. Cartmill1, D. Richardson2, J. Schumacher1, J. E. Kohler1 1University Of Wisconsin,Department Of Pediatric Surgery,Madison, WI, USA 2Wisconsin Health Information Organization,Fitchburg, WI, USA
Introduction: Current Food and Drug Administration (FDA) guidelines state that codeine should not be used in children <12 years old. Ultrametabolism of codeine by a subset of children can “carry serious risks including slowed or difficult breathing and death.” Despite the FDA’s black box warning, national data suggest that codeine is still prescribed to children. We sought to describe the prescription of codeine for common outpatient pediatric surgical procedures.
Methods: We collected data from the Wisconsin Health Information Organization (WHIO) for all opioid prescriptions in children <12 years old undergoing one of several common outpatient pediatric surgical procedures from Jan 2016-March 2018. Opioid prescriptions filled seven days before or after the index procedure were included. Procedures include a) strabismus repair, b) circumcision in children over 1 year old, c) laparoscopic appendectomy, d) orchiopexy, e) closed reduction and percutaneous pinning of the elbow, f) inguinal hernia repair, g) umbilical hernia repair and h) tympanostomy/myringotomy. Patients undergoing additional procedures at the time of the index operation were excluded from the study.
Results: Of 6949 children who were prescribed an opioid, 9.86% filled codeine prescriptions from Jan 2016-March 2018. The procedures most commonly prescribed codeine were strabismus repair (65.27% of opioid prescriptions), circumcision (20.73%), laparoscopic appendectomy (16.98%), orchiopexy (9.38%), closed reduction and percutaneous pinning of the elbow (8.56%) and inguinal hernia repair (8.31%).
Conclusion: Despite multiple warnings issued by the Food and Drug Administration, manychildren <12 years old in Wisconsin continue to fill prescriptions for codeine after common outpatient surgical procedures. If the provider feels that opioids are necessary, they should consider safer alternatives such as oxycodone or hydrocodone. Contra-indicated prescriptions, like codeine represent a target for future statewide quality improvement efforts by multi-disciplinary groups such as the Surgical Collaborative of Wisconsin, Safer Prescribing of Opioids after Trauma and Surgery (SPOTS) program, and Safer Opioids initiative. By engaging surgeon stakeholders with novel educational outreach activities, these groups aim to eliminate contraindicated peri-procedural codeine prescriptions for Wisconsin children.
