Post-operative Opioid Reduction Protocol Reduces Racial Disparity in Clinical Outcomes in Children.

Area of Science:

• Pediatric Surgery
• Health Equity
• Pain Management

Background:

• Racial disparities persist in pediatric surgical care outcomes.
• Clinical protocols may mitigate these disparities.
• A post-operative opioid reduction protocol was implemented for infants undergoing abdominal surgery.

Purpose of the Study:

• To determine if the opioid reduction protocol reduced racial disparity in post-operative opioid prescribing.
• To assess the protocol's impact on associated clinical outcomes stratified by race.

Main Methods:

• A pre-intervention (2011-2015) and post-intervention (2016-2021) cohort analysis was performed.
• The protocol included intravenous acetaminophen, staff education, and standardized sign-outs.
• Primary outcomes were post-operative opioid use and pain scores; secondary outcomes included clinical variables, all stratified by race.

Main Results:

• Before the protocol, Black children received significantly more opioids (13.1 mg/kg) than White children (2.1 mg/kg).
• After the protocol, opioid use was statistically identical between racial groups (0.05 mg/kg vs. 0.0 mg/kg).
• Racial disparities in length of stay (45 days vs. 16 days) and intubation duration were eliminated post-protocol.

Conclusions:

• The opioid reduction protocol effectively reduced racial disparities in pediatric post-operative opioid prescribing.
• The protocol also mitigated racial disparities in key clinical outcomes like length of stay and intubation duration.
• Standardized clinical protocols can improve health equity in pediatric surgical care.