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Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients
B R Garren1, M B Lawrence2, P P McNaull2
1The University of North Carolina at Chapel Hill, Department of Urology, USA.
Insights
Pediatric urology patients frequently receive excessive opioid prescriptions, leading to significant leftover medication. Poor perioperative education contributes to improper storage and disposal of these excess opioids.
Area of Science:
- Pediatric Surgery
- Pain Management
- Public Health
Background:
- Opioid prescribing practices are under-researched in pediatric surgery compared to adults.
- Understanding pediatric opioid use is crucial for addressing the opioid epidemic.
- Pediatric urologic surgery presents a unique area for examining opioid management.
Purpose of the Study:
- To investigate postoperative opioid prescribing and consumption patterns in pediatric urologic surgery.
- To analyze trends in the storage and disposal of opioid medications among pediatric patients.
- To identify gaps in perioperative education regarding opioid use.
Main Methods:
- Retrospective review of patients undergoing specific pediatric urologic procedures.
- Opioid medication details obtained from pharmacy databases.
- Postoperative opioid usage determined through guardian telephone surveys.
Main Results:
- Overprescription was prevalent, with an average excess of 9.8 doses (64% overprescription rate).
- 62% of patients had leftover opioids two weeks postoperatively.
- Only 13 patients received counseling on opioid storage and disposal, with 78% of those with leftovers not disposing of them properly.
Conclusions:
- Pediatric urologic procedures show non-standardized and excessive opioid prescribing.
- A significant quantity of unused opioids remains in pediatric homes due to overprescription.
- Inadequate perioperative education leads to widespread improper handling and disposal of excess opioids.
Background:
Emerging research on surgeons and the opioid epidemic have focused on the adult population. Consequently, little is known regarding opioid-prescribing practices in the pediatric population. The goal of this study is to examine postoperative opioid-prescribing and consumption patterns, as well as storage and disposal trends for specific pediatric urologic procedures.
Study Design:
Patients undergoing surgery associated with specified Current Procedural Terminology codes were retrospectively identified, and details regarding opioid medications were obtained through our pharmacy database. Patients' guardians were contacted two weeks postoperatively to determine opioid usage. Opioids were prescribed at a standard dosing of 0.1 mg/kg per dose or the equivalent.
Results:
Of the 171 identified patients, 117 patients were successfully contacted, with 67 (39%) completing telephone surveys. The 3 most common pediatric urology procedures were inguinal hernia repair (N = 39), circumcision (N = 27), and cystoscopy (N = 16). Across all procedures, there was an average excess of 9.8 doses prescribed, corresponding to an overprescription rate of 64%. Of the patients prescribed opioids, 41 (62%) had leftover opioid medication two weeks postoperatively. Thirty-two of 41 (78%) patients did not dispose of their leftover medication. Only 13 patients received perioperative counseling on appropriate storage and disposal of opiates.
Discussion:
Prescribing practices for an array of pediatric urologic procedures are non-standardized and often generously excessive. We show universal overprescribing for all our reviewed urologic procedures. Sixty-two percent of pediatric urology patients did not use their entire prescribed opiate, leaving a significant pool of medicine within the pediatric family home. Given the low incidence of perioperative education, unsurprisingly a majority of our patients improperly handled and disposed off excess opioid medication.
Conclusion:
There is general overprescription of postoperative opioids and poor perioperative opioid education in the pediatric urology population.
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