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Pediatric Post-Tonsillectomy Opioid Prescribing Practices.

Yusuf M Agamawi1, Lauren M Cass1, Maggie Mouzourakis2

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Summary
This summary is machine-generated.

Discharge order sets significantly reduced opioid prescribing after pediatric tonsillectomy, decreasing opioid dosage and total dispensed amounts. While reducing pain and dehydration, a temporary increase in hemorrhage readmissions was noted in older children.

Keywords:
Pediatricelectronic medical record (EMR)opioidsorder setstonsillectomy

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Area of Science:

  • Pediatric Surgery
  • Pain Management
  • Pharmacology

Background:

  • Opioid prescribing after pediatric tonsillectomy varies widely.
  • Standardized discharge protocols may optimize pain management and reduce opioid use.

Purpose of the Study:

  • To evaluate the impact of implementing discharge order sets on opioid prescribing patterns in pediatric tonsillectomy patients.
  • To assess secondary outcomes including postoperative pain, dehydration, and bleeding events.

Main Methods:

  • A retrospective chart review compared pre- and post-intervention pediatric patients (0-18 years) undergoing tonsillectomy.
  • Order sets included age-specific opioid defaults and recommended scheduled acetaminophen and ibuprofen.
  • Opioid outcomes were measured in morphine milligram equivalents per kilogram (MME/kg) and total doses prescribed.

Main Results:

  • Opioid dose prescribed decreased by 17% (0.095 MME/kg to 0.079 MME/kg).
  • Total opioid doses prescribed significantly reduced from 46.4 to 20.3.
  • Admissions for dehydration and pain decreased, but readmissions for hemorrhage increased in older children post-intervention.

Conclusions:

  • Standardized discharge order sets effectively reduced opioid prescribing and variability while maintaining pain control.
  • An increase in post-tonsillectomy hemorrhage was observed but did not persist.
  • Order sets represent a valuable tool for optimizing pediatric tonsillectomy pain management.