Discharge Opioid Prescriptions Following Pediatric Appendectomy: A NSQIP-P Study
Amna Minhas1, Humza Thobani2, Arsalan Javid3
1Loma Linda University Health, Department of General Surgery, Division of Pediatric Surgery, Loma Linda, CA, USA.
Introduction:
This study aimed to evaluate national patterns in opioid prescriptions following discharge for appendectomy in children with appendicitis using the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) database. Furthermore, we aimed to analyze the association between opioid prescriptions at discharge and emergency department (ED) visits and readmissions in this patient cohort.
Methods:
The NSQIP-P database was queried for all patients under 18 years of age who underwent laparoscopic appendectomy for simple or complicated appendicitis in 2023. Patients were stratified based on whether they received an opioid prescription at discharge. Demographics, clinical characteristics and postoperative outcomes were compared between patients receiving opioid prescriptions versus those who did not. Multivariable logistic regression was used to identify predictors of opioid prescribing and its association with ED visits and unplanned readmissions.
Results:
Among 22,148 pediatric appendectomy patients, 5.2 % received opioids at discharge. In patients with simple appendicitis, older age (p < 0.001), male sex (p = 0.027), Black/African American race (p = 0.012), computed tomography (CT) without ultrasound (p < 0.001) and shorter hospital stay (p = 0.002) were independent predictors of opioid prescription. In cases of complicated appendicitis, independent predictors of opioid prescription included older age (p = 0.001), CT without ultrasound (p < 0.001) and shorter hospital stay (p < 0.001). Discharge opioids were associated with increased odds of ED visits (aOR 1.28, 95 % CI: 1.00-1.60), but not unplanned readmissions (aOR 1.13, CI 95 %: 0.75-1.64).
Conclusion:
Despite declining national rates, variation in opioid prescribing following appendectomy persists. Poor radiation stewardship and patient demographics appear to be associated with prescribing patterns. Efforts to optimize pain management and reduce unnecessary opioid exposure are warranted.
Type Of Study:
Retrospective Comparative Study.
Level Of Evidence:
III.
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