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Opioid prescribing practices for pediatric tonsillectomy before and after policy interventions
Daniel Gerges1,2, Nicole Wershoven2, Richard Hubbell1,2
1Division of Otolaryngology University of Vermont Medical Center Burlington Vermont USA.
Insights
Statewide opioid prescribing policies significantly reduced opioid prescriptions for pediatric tonsillectomy patients. This change did not increase pain calls, readmissions, or emergency visits, demonstrating effective policy impact.
Area of Science:
- Pediatric Surgery
- Pain Management
- Public Health Policy
Background:
- Opioid prescribing after pediatric tonsillectomy is a significant concern.
- Statewide policy interventions aim to curb opioid use in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of statewide opioid prescribing policy interventions on pediatric tonsillectomy patients.
- To assess changes in opioid prescribing patterns before and after policy implementation.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) undergoing tonsillectomy or adenotonsillectomy.
- Comparison of opioid prescribing data from one year pre-policy (July 2016-June 2017) and one year post-policy (July 2017-June 2018).
- Data included demographics, procedure details, opioid prescriptions, and postoperative outcomes like calls and emergency department visits.
Main Results:
- Opioid prescription rates decreased significantly from 49.7% pre-policy to 15.4% post-policy.
- For patients aged 6 years and older, opioid receipt dropped from 95.8% to 25.2%.
- No significant differences were observed in pain-related calls, postdischarge opioid prescriptions, or emergency department visits between the two periods.
Conclusions:
- Statewide policy interventions effectively reduced opioid prescribing for pediatric tonsillectomy.
- These policies can be implemented without negatively impacting patient pain management or increasing healthcare utilization for complications.
Objective:
This study's purpose was to investigate opioid prescribing practices after pediatric tonsillectomy in the year before and year after implementation of statewide policy interventions in Vermont.
Methods:
We reviewed charts of consecutive patients less than 18 years old that underwent tonsillectomy or adenotonsillectomy at a single tertiary academic medical center 1 year before (July 2016-June 2017) and 1 year after (July 2017-June 2018) implementation of policy interventions targeted at opioid prescribing. Data collected included demographics, procedure performed, indication, complications, medical comorbidities, opioid prescribing practices (medication, dose, morphine milliequivalents, and postdischarge opioid prescriptions), and postoperative telephone calls and emergency department (ED) visits.
Results:
Tonsillectomy or adenotonsillectomy was performed in 360 consecutive patients (185 in the pre-policy year and 175 in the post-policy year). Those receiving an opioid prescription in the pre- compared to post-policy year was 49.7% versus 15.4% (p < .001). Of patients 6 years and older, 95.8% in the pre-policy year compared to 25.2% in the post-policy year received a postoperative opioid (p < .001). There was no difference in pain-related office phone calls, postdischarge opioid prescriptions or ED visits between the two groups. There was no difference in morphine milligram equivalent prescribed in the pre- and post-groups.
Conclusion:
Implementation of statewide policy interventions can have a substantial impact on opioid prescribing practices in the pediatric tonsillectomy population without an increase in office phone calls, postdischarge opioid prescriptions, and ED visits.
Level Of Evidence:
4.
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