Opioid Utilization after Cardiac Surgery in the Pediatric Medicaid-Insured Population

Area of Science:

• Pediatric Cardiology
• Pain Management
• Health Services Research

Background:

• Outpatient opioid prescribing patterns after pediatric cardiac surgery exhibit considerable variability.
• Understanding these variations is crucial for ensuring equitable and safe pain management.
• Previous research has not comprehensively analyzed these prescribing trends across diverse demographic and geographic factors.

Purpose of the Study:

• To investigate the variations in outpatient opioid prescribing practices among pediatric patients undergoing cardiac surgery across the United States.
• To identify demographic and regional factors associated with differences in opioid prescription use, duration, and dosage.

Main Methods:

• Retrospective, cross-sectional analysis of Medicaid claims data from 2016-2018.
• Included children aged 0-17 years discharged after cardiac surgery and receiving an opioid prescription within 30 days.
• Prescriptions were quantified in morphine milligram equivalents (MME); analysis by sex, race, ethnicity, urbanicity, and region.

Main Results:

• Of 17,186 children, 2,129 received opioids post-discharge.
• Females received lower opioid doses than males (P=0.022).
• Hispanic individuals were less likely to receive opioids and for shorter durations (P<0.05). Prescribing varied significantly by region, with Midwest and Northeast regions showing lower likelihood but higher doses compared to the Southeast.

Conclusions:

• Significant disparities in outpatient opioid prescribing exist for pediatric cardiac surgery patients based on race, ethnicity, sex, and geographic region.
• Development of national guidelines for outpatient opioid use in this population is recommended.
• Standardized guidelines can help reduce practice variation and mitigate potential harms associated with outpatient opioid therapy.