Impact of Opioid Limiting Legislation on Prescribing in Adolescent Breast Surgery at a Tertiary Pediatric Hospital

The opioid epidemic is a critical issue in the adult and pediatric populations. This study examined the change in perioperative and discharge prescribing of opioids in adolescent breast surgical patients at a tertiary pediatric hospital in response to statewide opioid-limiting legislation.

Adolescent breast surgical encounters between 2014 and 2023 were grouped into 3 cohorts: breast asymmetry, breast reduction, and gynecomastia. Primary outcomes included the quantity of oral morphine equivalents (OMEs) consumed while inpatient, prescription size at discharge, and adherence to state-limiting opioid legislation. Secondary outcomes included risk factors for opioid use and the proportion of patients using nonopioid alternatives.

A total of 330 surgical encounters were identified. Median (interquartile range) inpatient opioid consumption in breast reduction patients was greater (11.3 [6.00-22.5] OMEs, P < 0.001) than breast asymmetry (5.00 [0.00-15.0] OMEs) and gynecomastia (0.00 [0.00-5.00] OMEs) patients. On multivariable regression, admission length and body mass index were associated with increased inpatient opioid consumption, and surgeon-administered local anesthesia was associated with decreased inpatient opioid use. Adjusted cumulative inpatient OME consumption by hospital admission length to hourly OME revealed that gynecomastia patients receive significantly fewer OMEs (P = 0.014). At discharge, operating length contributed to an increased discharge prescription quantity, whereas implementation of state legislation was associated with a reduced discharge quantity.

This study described shifts in prescriber patterns for adolescent breast surgery following the enactment of opioid restriction legislation. These findings provide valuable targets for quality improvement initiatives and the generation of standardized procedure-specific prescribing guidelines.