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Published on: February 27, 2018
Prescription vs. consumption: Opioid overprescription to children after common surgical procedures
Liese C C Pruitt1, Douglas S Swords1, Katie W Russell2
1University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT; Intermountain Healthcare, Murray, UT.
Insights
Pediatric surgical patients were prescribed more opioid pain medication than they needed, yet reported good pain control. This overprescribing contributes to excess opioids in the community, fueling the opioid epidemic.
Area of Science:
- Pediatric Surgery
- Pain Management
- Public Health
Background:
- Concerns exist regarding routine opioid overprescription postoperatively, contributing to excess community opioid supplies amidst a national epidemic.
- Understanding prescribing patterns and patient consumption is crucial for addressing opioid misuse.
Purpose of the Study:
- To examine current opioid prescribing practices by surgeons.
- To assess the consumption of prescribed opioids by pediatric surgical patients after discharge.
Main Methods:
- An emailed survey was administered to postoperative patients (January 2017 onwards) across a 23-hospital system.
- The survey collected data on prescribed versus consumed opioids and pain control.
- Responses from pediatric patients aged 10-18 were specifically analyzed.
Main Results:
- 277 pediatric patients' data were analyzed, revealing significant overprescription of opioids compared to consumption across various surgical procedures.
- For example, appendectomy patients were prescribed a median of 10 opioid equivalents versus consuming 2.
- Despite using fewer opioids, 84% of patients reported good pain control, and 64% of those with excess opioids kept them at home.
Conclusions:
- Surgeons frequently prescribe more opioid tablets than pediatric patients utilize for postoperative pain.
- Patients consistently report adequate pain management with less medication than prescribed.
- Current prescribing habits contribute to the surplus of unused opioids in homes, exacerbating the opioid crisis.
Background:
In the setting of a national opioid epidemic there are concerns about routine overprescription of opioids postoperatively in both children and adults, which introduces excess opioids into the community.
Purpose:
We sought to examine current opioid prescribing practices by surgeons and consumption of prescribed opioids by pediatric surgical patients following discharge.
Methods:
Starting in January 2017 we began an emailed survey for all postoperative patients in a 23-hospital system about the opioids they were prescribed and consumed following discharge. They were then asked if their pain was controlled. Responses of pediatric patients (age 10-18) were examined.
Findings:
Data from 277 patients were analyzed. After surgical procedures, patients were prescribed significantly more opioids (given in hydrocodone 5 mg equivalents) than they consumed: for appendectomy (median 10 vs. 2) cholecystectomy (12 vs. 5), hernia repair (20 vs. 14), tonsillectomy (30 vs. 17), sinus surgery (30 vs. 5), septoplasty (27 vs. 9.5), knee arthroscopy (30 vs. 12.5), open reduction and internal fixation (ORIF) of the hand and wrist (20 vs. 8.5), and ORIF of the foot and ankle (27 vs. 13.5). The majority (84%) of patients agreed or strongly agreed with the statement that their pain was controlled. Of patients with excess opioids, 64% reported keeping them in their home.
Conclusions:
Providers prescribed more opioid tablets than were used by patients. Despite using fewer tablets, patients reported good pain control. Current prescribing practices contribute to excess opioids in the community and represent an opportunity to alter the current epidemic.
Level Of Evidence:
III.
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