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J Pediatr Surg. 2019 Jul;54(7):1427-1431. doi: 10.1016/j.jpedsurg.2018.07.002. Epub 2018 Jul 7.

Inconsistent and excessive opioid prescribing after common pediatric surgical operations.

Author information

1
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA. Electronic address: hortojos@musc.edu.
2
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
3
Division of Pediatrics, College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
4
Division of Pediatric Surgery, Department of General Surgery, Medical University of South Carolina, Charleston, SC, USA.

Abstract

OBJECTIVES:

Opioid misuse has reached epidemic proportions in the United States. Post-operative opioids have been linked to overdose, diversion, and dependency in adults, but comparatively less is known in children. We evaluated opioid prescriptions following tonsillectomy and hernia repair at our institution.

METHODS:

Retrospective chart review of all outpatient tonsillectomies and inguinal/umbilical hernia repairs at a single institution. Data on opioid and non-opioid analgesic prescription characteristics and post-operative pain control were reviewed.

RESULTS:

470 procedures were reviewed (276 tonsillectomy, 194 hernia repair). In patients with an indication (> 5 years-old in tonsillectomy, > 1 year-old in hernia repair), 85.0% and 85.6% received a post-op opioid prescription, respectively. Mean days' opioid supplied was 6.19 +/- 4.39 days in tonsillectomy and 4.30 +/- 2.94 days for hernia repair. There was significant inter- and intra-provider variation in the days' supplied of post-operative opioid. 90-100% of patients reported adequate pain control at discharge callback regardless of pain control regimen (opioid alone, opioid + non-opioid analgesic, non-opioid analgesic alone).

CONCLUSIONS:

Significant variation in post-operative prescribing practices was identified as well as overall over-prescription, which will serve as a starting point to institute evidence-based intervention to reduce post-operative opioid misuse after these common pediatric surgical procedures.

LEVEL OF EVIDENCE:

IV.

KEYWORDS:

Opioids; Post-operative Narcotics; Quality Improvement

PMID:
30057208
DOI:
10.1016/j.jpedsurg.2018.07.002
[Indexed for MEDLINE]

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