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Post-Tonsillectomy Outcomes in Children With and Without Narcotics Prescriptions
Michele M Carr1, Eric W Schaefer2, Jane R Schubart2,3
1Department of Otolaryngology, 53422West Virginia University, Morgantown, WV, USA.
Insights
Outpatient narcotic prescriptions after pediatric tonsillectomy showed minor outcome differences. While narcotics slightly increased bleeding and emergency visits, they significantly lowered readmission rates.
Area of Science:
- Pediatric Otolaryngology
- Pain Management
- Health Services Research
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Postoperative pain management is crucial for recovery.
- The role of outpatient narcotic prescriptions in pediatric tonsillectomy outcomes requires further investigation.
Purpose of the Study:
- To compare outcomes in children undergoing tonsillectomy who received outpatient narcotic prescriptions versus those who did not.
- To identify differences in postoperative complications, healthcare utilization, and costs.
Main Methods:
- Analysis of the MarketScan database (2008-2012) for privately insured children (1-17 years) undergoing tonsillectomy/adenotonsillectomy.
- Comparison of outcomes including bleeding, dehydration, emergency department (ED) visits, readmissions, and total costs within 14 days post-surgery.
- Statistical analysis to determine significant differences between groups receiving and not receiving narcotic prescriptions.
Main Results:
- Of 294,795 patients, 60.9% received narcotic prescriptions.
- Narcotic use was associated with a statistically significant increase in bleeding complications (2.7% vs 2.5%) and ED visits (6.8% vs 6.6%).
- A significantly lower readmission rate (1.0% vs 1.5%) was observed in the narcotic group. No significant difference in dehydration. Higher costs noted in 4-6 year olds receiving narcotics.
Conclusions:
- Small but statistically significant differences in outcomes were observed between children receiving and not receiving outpatient narcotics post-tonsillectomy.
- The primary benefit identified for narcotic use was a reduced rate of hospital readmissions.
- Findings suggest a nuanced approach to pediatric pain management after tonsillectomy, balancing potential risks and benefits.
Objective:
To examine differences in outcomes after tonsillectomy in children who received outpatient narcotics prescriptions compared to those who did not.
Methods:
The MarketScan database was analyzed for claims made for 14 days following tonsillectomy/adenotonsillectomy between 2008 and 2012 for privately insured children 1 to 17 years. Post-op bleeding, dehydration, emergency department (ED) visits, readmissions, and mean total costs for the 14 days after tonsillectomy were compared.
Results:
Of the 294 795 patients included, 60.9% received a narcotic prescription. Acetaminophen/hydrocodone bitartrate was received by 53.2% of the group receiving narcotic drugs, 42.5% received acetaminophen/codeine phosphate, 3.0% received acetaminophen/oxycodone hydrochloride, and 0.5% received oxycodone hydrochloride alone. Children who had been prescribed narcotics had significantly higher percentages of bleeding complications (2.7% vs 2.5%, P < .001), and ED visits (6.8% vs 6.6%, P < .001) within 14 days, but a lower percentage of readmissions (1.0% vs 1.5%, P < .001). No significant difference was observed between groups for dehydration. There were some age-related differences. The mean total health-care costs for 14 days post-op were the same in each group, except for the 4- to 6-year-olds, where the narcotic group had higher costs (US $7060 vs US $5840, P = .006).
Conclusion:
In this large-scale study, we found small but statistically significant differences in outcomes related to use of narcotics. The only outcome that benefitted the narcotics group was a lower readmission rate.
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