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Preoperative Opioid Informed Consent and Prescribing Practices in Children Undergoing Orthopaedic Trauma Surgery

Brendan A Williams1, Lacey C Magee, Christopher A Makarewich

  • 1From the Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA (Dr. Williams, Dr. McNeely, and Dr. Shah); the Department of Otolaryngology, Cleveland Clinic, Cleveland, OH (Dr. Magee); the Department of Orthopaedics, University of Utah, Salt Lake City, UT (Dr. Makarewich); and the Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA (Dr. Swarup).

Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews
|January 25, 2022
PubMed

Insights

State-mandated informed consent for opioids reduced opioid prescribing for pediatric orthopaedic trauma surgery patients. This intervention also increased nonopioid medication use without affecting pain control.

Area of Science:

  • Orthopaedic Surgery
  • Pediatric Trauma
  • Pain Management
  • Pharmacology

Background:

  • Opioid prescribing for pediatric orthopaedic trauma surgery requires careful consideration due to potential risks.
  • State-mandated informed consent for opioids is a recent development aimed at improving patient and family understanding of risks and alternatives.

Purpose of the Study:

  • To examine opioid prescribing practices in pediatric orthopaedic trauma surgery.
  • To assess the impact of state-mandated preoperative informed consent for opioids on prescribing patterns.

Main Methods:

  • Retrospective single-institution cohort study.
  • Involved 1,793 pediatric patients with isolated orthopaedic trauma between 2016 and 2018.
  • Compared opioid prescribing based on the presence or absence of preoperative opioid consent.

Main Results:

  • Patients with preoperative opioid consent received fewer opioid doses (P < 0.001).
  • The proportion of patients prescribed opioids was lower in the consented group (P = 0.0378).
  • Prescribing of nonopioid medications increased, with no significant difference in refill needs or pain control proxies.

Conclusions:

  • Implementation of preoperative opioid consent is associated with reduced opioid prescribing in pediatric orthopaedic trauma surgery.
  • Increased awareness of opioid risks through formal consent may decrease opioid reliance in pediatric postoperative care.
  • Nonopioid pain management strategies were utilized more frequently following consent implementation.
Abstract

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