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Opioid Prescription Patterns 30 Days After Pediatric Supracondylar Humerus Fracture Closed Reduction and Percutaneous
Jack M Haglin1, David G Deckey1, Tony Gaidici2
1Department of Orthopedics, Mayo Clinic Arizona.
Insights
Nearly half of pediatric patients with supracondylar humerus fractures (SCH) received opioid prescriptions post-surgery. However, opioid prescribing has significantly decreased since 2010, though further reductions are possible.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pain Management
Background:
- Supracondylar humerus fractures (SCH) are common pediatric elbow fractures, often requiring surgical intervention.
- Postoperative pain management for SCH exhibits significant variability, with a notable risk of morbidity from pediatric opioid consumption.
- Characterizing prescription patterns is crucial for optimizing pain management and reducing opioid reliance.
Purpose of the Study:
- To analyze national prescription patterns for postoperative pain following closed reduction and percutaneous pinning (CRPP) of SCH in pediatric patients.
- To identify trends in opioid prescribing and factors associated with increased or decreased opioid utilization.
Main Methods:
- Retrospective analysis of the PearlDiver Mariner Claims Database for patients aged 10 or younger undergoing SCH CRPP (2010-2021).
- Primary outcome: postoperative pain medication prescriptions within 30 days of SCH CRPP.
- Analysis included patient demographics, prescription duration, morphine milligram equivalents (MME), and multivariable regression to identify associated factors.
Main Results:
- Over 43,000 SCH CRPP cases were identified; 48.6% received narcotic prescriptions.
- Opioid prescription rates declined from 54.7% in 2010 to 27.4% in 2021.
- Factors associated with increased opioid prescriptions included older age, higher comorbidity index, and Medicaid insurance; decreased prescriptions were linked to Northeast location, higher family income, and commercial insurance.
Conclusions:
- Nearly half of pediatric patients treated with SCH CRPP received opioid prescriptions over the past decade.
- A significant downward trend in opioid prescribing was observed, reaching 27.4% in 2021.
- Patients with higher comorbidities, Medicaid insurance, or lower family income may be at increased risk for opioid overprescription, highlighting the need for continued efforts to reduce opioid use.
Background:
Supracondylar humerus fractures (SCH) are the most common type of elbow fracture in children, with many cases requiring surgery. Treatment of postoperative pain for SCH has high variability, but can often be treated effectively with minimal or no opioids. Furthermore, there is significant morbidity related to pediatric opioid consumption. The goal of this study was to characterize prescription patterns in the United States following closed reduction and percutaneous pinning (CRPP) of SCH.
Methods:
All patients aged 10 or younger years who underwent CRPP of SCH from January 2010 to December 2021 were identified in the PearlDiver Mariner Claims Database. The primary outcome was postoperative pain medication prescriptions in the 30 days following SCH CRPP. Patient demographics, prescription duration, and morphine milligram equivalents (MME) were analyzed. Multivariable-log-binomial mixed regression models were constructed to assess factors associated with increased opioid prescription.
Results:
In total, 43,611 SCH CRPP cases in patients aged 10 or younger were identified from 2010 to 2021. Throughout the study period, 48.6% of patients (21,191/43,611) received and filled a narcotic pain prescription. The percentage of patients receiving opioid medication decreased from 54.7% in 2010 to 27.4% in 2021. Opioid prescriptions totaled a mean of 6.1±2.1 days of narcotics with a mean of 79.2 MME prescribed per patient. Increased patient age, increased Elixhauser comorbidity index, and Medicaid insurance were all associated with increased opioid prescription ( P <0.001). Living in the Northeast, increased family income, and commercial insurance were associated with decreased opioid prescriptions ( P <0.001).
Conclusions:
Nearly half of the patients over the past decade treated with CRPP for SCH received a narcotic prescription. However, there has been a steady decline in the proportion of patients being prescribed opioids, with only 27.4% receiving opioids in 2021. Further, patients with increased comorbidities or those insured by Medicaid with lower mean family income may be at risk for increased opioid prescription. While efforts have been made to reduce opioid overprescribing, there continues to be room for further reduction in opioid utilization after CRPP for SCH moving forward.
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