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Postoperative pediatric urology opioid prescriptions at a tertiary academic medical center
Laura Donnelly1, Paul J Feustel2, Theodore Cangero2
1Division of Urology, Albany Medical College, 23 Hackett Boulevard, Albany, NY, 12208, USA.
Insights
Postoperative opioid prescriptions are infrequent in pediatric urology, with most occurring in older children undergoing penile and scrotal procedures. Prescribing rates have decreased significantly over time.
Area of Science:
- Pediatric Surgery
- Urology
- Pain Management
- Public Health
Background:
- Opioid abuse is a significant public health concern, with postoperative prescriptions often initiating opioid use.
- Limited data exist on opioid prescribing patterns in pediatric urology practices.
- This study addresses the need for data on postoperative opioid prescriptions in pediatric urologic surgery.
Purpose of the Study:
- To determine the rates of postoperative opioid prescriptions following urologic surgery in a tertiary academic center.
- To identify factors associated with opioid prescription following pediatric urologic procedures.
- To analyze trends in opioid prescribing over a three-year period.
Main Methods:
- Retrospective review of opioid prescriptions for pediatric patients undergoing surgery between January 1, 2017, and December 31, 2019.
- Data collected included patient demographics, surgical procedure, length of stay, and pre-operative opioid use.
- Multivariable logistic regression was used to identify factors associated with opioid prescription.
Main Results:
- Of 1102 procedures, 14.2% resulted in opioid prescriptions.
- Scrotal surgery (OR 1.42) was associated with increased odds of prescription, while hypospadias repair, pyeloplasty, and ureteral reimplantation were associated with decreased odds (OR 0.53-0.55).
- Opioid prescribing rates decreased from 18% in 2017 to 7.7% in 2019.
Conclusions:
- Pediatric urologic surgery has a low rate of postoperative opioid prescribing, with 85.8% of patients not receiving opioids.
- Increasing patient age and scrotal surgery were associated with a higher likelihood of opioid prescription.
- Heightened awareness has led to a significant decrease in opioid usage over time, indicating effective stewardship.
Introduction:
Opioid abuse is a public health crisis, and often this starts postoperatively. Limited data are available on pediatric urology practitioners. We examined the likelihood of postoperative opioid prescriptions in our practice.
Objective:
To determine rates of post-operative opioid prescriptions following urologic surgery in a tertiary academic center, and to identify what factors are related to opioid prescriptions.
Study Design:
We retrospectively reviewed opioid prescriptions for children who underwent a procedure in the operating room between 1/1/17 and 12/31/19. We collected data on gender, age, surgeon, procedure, length of stay, ethnicity, race, and whether opioids had been used pre-operatively. We grouped procedures into five categories: minor penile surgery, cystoscopic procedures, scrotal surgery, hypospadias repair/penoplasty, and pyeloplasty/ureteral reimplant. Multivariable logistic regression was used to determine odds ratios (OR) of opioid prescriptions.
Results:
1102 procedures had data available. 14.2% (n = 156) received opioid prescriptions. Using minor penile surgery as a baseline, scrotal surgery increased the odds of an opioid by 1.42; hypospadias, pyeloplasty, and other procedures reduced the odds by 0.53, 0.55, and 0.54, respectively (no patient received opioids for endoscopic procedures). Ambulatory procedures had a lower rate of opioids (0.40), and age was a major factor, with the odds of a prescription increasing by a factor of 1.45 per year of age. Since January of 2017, the opioid prescription rate has decreased from 18% in 2017 to 7.7% in 2019.
Discussion:
We found a relatively low rate of opioid prescribing in our pediatric patients, mostly in older children undergoing penile and scrotal procedures. Our rate was comparable to several other institutions that have examined their prescription rates in surgical patients. Heightened awareness has resulted in decreased opioid usage over time (to 6.9%). Limitations included the retrospective nature of our study, which did not allow us to assess whether pain control was adequate or if the opioids prescribed were used by patients. Opioids are rarely needed in pediatric patients.
Conclusions:
85.8% of post-operative pediatric urology patients at our institution were not provided with prescription opioids. Factors associated with a higher likelihood of receiving a prescription were increasing age and scrotal surgery.
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