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Impact of state legislation and institutional protocols on opioid prescribing practices following pediatric
Lisa M Einhorn1, Congwen Zhao2, Benjamin A Goldstein2,3
1Division of Pediatric Anesthesiology, Department of Anesthesiology Duke University Medical Center Durham North Carolina USA.
Insights
Opioid prescriptions for pediatric tonsillectomy decreased significantly after state legislation and institutional changes, reducing oxycodone doses by 40%. However, variability in prescribing practices persisted despite interventions.
Area of Science:
- Pediatric Otolaryngology
- Pain Management
- Public Health Policy
Background:
- Tonsillectomy is a common pediatric surgery with pain management being a key recovery aspect.
- The opioid epidemic has led to restrictions on postoperative opioid use in children.
- Few studies have evaluated the impact of these opioid restrictions on pediatric otolaryngology practices.
Purpose of the Study:
- To analyze changes in opioid prescribing patterns after North Carolina's opioid legislation and institutional protocol implementation.
- To quantify the reduction in oxycodone doses prescribed for pediatric tonsillectomy patients.
Main Methods:
- A single-center retrospective cohort study analyzed 1552 pediatric tonsillectomy patient records from 2014 to 2021.
- Prescribing practices were assessed across three periods: pre-legislation, post-legislation/pre-protocol, and post-protocol.
- The primary outcome measured was the number of oxycodone doses per prescription.
Main Results:
- Mean oxycodone doses per prescription decreased from 58±53 (Period 1) to 28±36 (Period 2) and 23±17 (Period 3).
- Interventions were associated with a 41% and 40% reduction in doses in Periods 2 and 3 compared to Period 1.
- Annual dosage decrease of 9% was observed after 2018 North Carolina legislation, but significant variability remained.
Conclusions:
- Legislative and institutional interventions significantly reduced oxycodone prescribing for pediatric tonsillectomy.
- A 40% decrease in oxycodone doses per prescription was observed post-interventions.
- Despite reductions, variability in opioid prescription regimens persisted, indicating a need for further optimization.
Objectives:
Tonsillectomy is a common pediatric surgery, and pain is an important consideration in recovery. Due to the opioid epidemic, individual states, medical societies, and institutions have all taken steps to limit postoperative opioids, yet few studies have examined the effect of these interventions on pediatric otolaryngology practices. The primary aim of this study was to characterize opioid prescribing practices following North Carolina state opioid legislation and targeted institutional changes.
Methods:
This single center retrospective cohort study included 1552 pediatric tonsillectomy patient records from 2014 to 2021. The primary outcome was number of oxycodone doses per prescription. This outcome was assessed over three time periods: (1) Before 2018 North Carolina opioid legislation. (2) Following legislation, before institutional changes. (3) After institutional opioid-specific protocols.
Results:
The mean (± standard deviation) number of doses per prescription in Periods 1, 2, and 3 was: 58 ± 53, range 4-493; 28 ± 36, range 3-488; and 23 ± 17, range 1-139, respectively. In the adjusted model, Periods 2 and 3 had lower doses by -41% (95% CI -49%, -32%) and -40% (95% CI -55%, -19%) compared to Period 1. After 2018 North Carolina legislation, dosage decreased by -9% (95% CI -13%, -5%) per year. Despite interventions, ongoing variability in prescription regimens remained in all periods.
Conclusion:
Legislative and institution specific opioid interventions was associated with a 40% decrease in oxycodone doses per prescription following pediatric tonsillectomy. While variability in opioid practices decreased post-interventions, it was not eliminated.
Level Of Evidence:
3.
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