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J Pediatr Surg. 2019 May 11. pii: S0022-3468(19)30344-6. doi: 10.1016/j.jpedsurg.2019.04.035. [Epub ahead of print]

Provider education decreases opioid prescribing after pediatric umbilical hernia repair.

Author information

1
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
2
Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
3
Department of Pediatric Surgery, The University of Chicago Medical Center, Chicago, IL, USA.
4
Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA.
5
Division of Pediatric Surgery, Medical University Of South Carolina, Charleston, SC, USA.
6
Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
7
Division of Pediatric Surgery, Department Of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA.
8
Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, TN, USA.
9
Division of Pediatric Surgery, Baylor College of Medicine, TX, USA.
10
Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, MD, USA.
11
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: mraval@luriechildrens.org.

Abstract

PURPOSE:

To improve opioid stewardship for umbilical hernia repair in children.

METHODS:

An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared.

RESULTS:

A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001) post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18-0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts.

CONCLUSIONS:

Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention.

TYPE OF STUDY:

Retrospective cohort study.

LEVEL OF EVIDENCE:

Level II.

KEYWORDS:

Opioid stewardship; Opioids; Pain control; Pediatrics; Provider education; Umbilical hernia repair

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