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Pilot implementation of opioid stewardship measures using the national surgical quality improvement program-pediatric
Martha-Conley E Ingram1, Yao Tian1, Sarah Kennedy2
1Feinberg School of Medicine, Department Of Surgery, Division of Pediatric Surgery, Northwestern University, Chicago, IL, USA.
Insights
Collecting data on pediatric postoperative opioid prescribing is feasible using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P). This study assessed pain management practices and found most opioid prescriptions met safety guidelines.
Area of Science:
- Pediatric Surgery
- Pain Management
- Health Services Research
Background:
- Optimal pediatric postoperative opioid prescribing data is limited.
- The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) is a valuable registry for surgical quality data.
- Assessing the feasibility of enhanced data collection for pediatric perioperative pain management is crucial.
Purpose of the Study:
- To evaluate the feasibility of collecting additional data on pediatric perioperative pain management and opioid prescribing at discharge.
- To leverage the ACS NSQIP-P for enhanced data collection on pediatric surgical patients.
- To analyze predictors of opioid prescribing and adherence to safety guidelines.
Main Methods:
- Added 19 novel data elements to ACS NSQIP-P for patients aged 5-18 years undergoing surgery.
- Collected metrics on data abstraction time and variable completion rates.
- Utilized univariate and logistic regression analyses to identify predictors of opioid prescribing and adherence to FDA recommendations.
Main Results:
- Median abstraction time for novel variables decreased significantly over 13 months, with a 94% completion rate.
- Of 878 patients, 36.4% received opioid prescriptions at discharge.
- Older age, white race, orthopedic surgery, and regional blocks were associated with opioid prescriptions; all met FDA guidelines.
Conclusions:
- Data collection on pediatric pain management and opioid prescribing is feasible with minimal burden using ACS NSQIP-P.
- Current opioid prescribing practices largely adhere to FDA safety recommendations.
- Further data collection is necessary to establish generalizable optimal prescribing practices for pediatric post-discharge pain management.
Introduction:
Data surrounding optimal pediatric postoperative opioid prescribing are incomplete. The objective of this study was to leverage the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P) and assess feasibility of added data collection surrounding pediatric perioperative pain management practices including opioid prescribing at discharge.
Methods:
Nineteen (19) novel data elements were added to NSQIP-P data collection of selected patients, ages 5-18 years, who had undergone surgery at a single, free-standing children's hospital. Metrics around data abstraction and completion of variables were collected. Univariate analyses (using Chi-square or Wilcoxon Rank Sum tests) and multiple logistic regressions were performed to describe predictors of opioid prescribing at discharge and to monitor adherence to Food and Drug Administration (FDA) prescribing recommendations.
Results:
Median abstraction time of the novel variables decreased from 12 to 5 min per patient over 13 months with 94% variable completion rate. Of 878 patients, 302 (36.4%) were prescribed opioids at discharge. Factors associated with an opioid prescription included older age (p < 0.001), white race (p < 0.05), undergoing an orthopedic surgery (p < 0.001), and receiving a regional block perioperatively (p < 0.001). All opioid prescriptions met FDA guidelines with no patients receiving codeine, and 98% of patients receiving opioid prescriptions < 50 morphine milli-equivalents per day.
Conclusion:
Collecting data on current pain management practices, opioid prescribing, and adherence to safety recommendations is feasible using the NSQIP-P with little added burden. Further expansion of data collection is needed to develop generalizable optimal prescribing practices for post-discharge pain management for children.
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