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Opioid Prescription Patterns for Children Following Laparoscopic Appendectomy
Kristin A Sonderman1,2, Lindsey L Wolf1,2, Arin L Madenci1,2,3
1Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA.
Annals of Surgery
|January 3, 2019
Summary
Opioid prescriptions after pediatric appendectomy vary significantly. Longer opioid durations increase the risk of emergency department visits for constipation in children, but not for pain or refills.
Area of Science:
- Pediatric Surgery
- Pain Management
- Opioid Prescribing Practices
Background:
- Postoperative opioid prescribing patterns in children may contribute to persistent opioid use.
- Understanding variability and consequences of opioid prescriptions after pediatric laparoscopic appendectomy is crucial.
Purpose of the Study:
- To describe variability in opioid prescriptions following pediatric laparoscopic appendectomy.
- To evaluate the consequences of opioid prescribing patterns on outcomes such as refills and emergency department visits.
Main Methods:
- Retrospective cohort study of children (<18 years) undergoing uncomplicated laparoscopic appendectomy (2006-2014) in the Military Health System.
- Primary outcome: days of opioids prescribed. Secondary outcomes: opioid refills, emergency department (ED) visits for constipation, and ED visits for pain.
- Associations evaluated with discharging service and opioid prescription duration.
Main Results:
- 68% of 6732 children received opioid prescriptions (median 4 days).
- General surgery services prescribed longer opioid durations compared to pediatric surgery services.
- Increased opioid prescription duration was associated with a higher risk of ED visits for constipation, but not for pain or refills.
Conclusions:
- Substantial variation exists in opioid prescribing patterns for pediatric appendectomy.
- Longer opioid prescription durations are linked to increased risk of ED visits for constipation.
- Opioid prescription duration did not significantly impact the need for refills or ED visits for pain.
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