N. G. Jayarajan1, Y. Young1, I. Anderson1, K. Sutyak1, N. Hebballi1, E. Garcia1, M. Broussard1, T. Fisher1, K. Lally1, K. Tsao1 1University Of Texas Health Science Center At Houston, Pediatric Surgery, Houston, TX, USA
Introduction:
The opioid epidemic has become a public health crisis. Prescribing patterns in adult populations have been investigated and guidelines have been published to reduce the use and misuse of opioids. However, there is limited literature on opioid prescribing in pediatric populations. Thus, we aimed to understand the prescribing patterns of pediatric general surgeons to identify what procedures opioids are currently being prescribed for.
Methods:
A retrospective chart review of all pediatric patients (≤18 years) who underwent general surgery procedures at a tertiary hospital between July 01, 2021, and July 01, 2023, was conducted. Patient’s demographics, procedures, and opioid prescriptions (medication name and dose) at the time of discharge were collected from their medical records. Opioid dosing data was converted to morphine milligram equivalents (MME). Descriptive statistics were performed.
Results:
Of the 4,323 patients, only 9.0% received an opioid prescription at the time of discharge from 9 pediatric surgeons. Among those who received opioids, most were for burns (82.1%), followed by trauma (6.6%) and pectus excavatum surgery (4.3%). Common pediatric surgery operations such as appendectomy, inguinal hernia repair, circumcision, and umbilical hernia repair did not receive opioid prescriptions (Figure 1). The average patient’s age who received opioid prescriptions was 6.1 (±5.2) years, with 58.6% being male. About 82.6% of patients who received opioid prescriptions also received prescriptions for non-narcotic analgesics. The mean narcotic absolute number of prescribed doses was 12.4 (±9.0) for burns, 14.0 (±12.3) for trauma, and 12.4 (±4.9) for pectus excavatum surgery. Overall, 99.5% of prescriptions were for oxycodone, with 2 patients being prescribed methadone. When converted to MME, the average total narcotic dose for the aforementioned three groups was 41.9 (±35.6).
Conclusion:
Overall, only a small proportion of pediatric general surgery patients receive opioid prescriptions at the time of discharge. As a result of an opioid stewardship program, post-discharge opioid prescriptions appear to be limited to a few conditions (burns, trauma, and pectus excavatum surgery). Future research and quality improvement should focus on understanding patient needs and utilization of prescribed narcotics.
