National variation in opioid prescribing after pediatric umbilical hernia repair

Cartmill, Randi; Yang, Dou‐Yan; Fernandes‐Taylor, Sara; Kohler, Jonathan E.

doi:10.1016/j.surg.2018.10.029

Cited by 35 publications

(20 citation statements)

References 20 publications

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“…In 2012, more than a third of prescriptions written by American surgeons were for opioids (13). Despite such a large portion of surgical prescriptions being for this one class of drug, there is little uniformity in how they are prescribed (48)(49)(50).…”

Section: What Do We Know About Post-operative Prescribing? Variationsmentioning

confidence: 99%

“…Variability in prescribing practices has been documented in many different domains. In a recent study of pediatric umbilical hernia patients, rates of opioid prescribing varied significantly between census regions, with a rate of 42% in the Northeastern and 59% in the Southern United States (50). It is important to note that such disparities do not only exist on a regional level.…”

Section: What Do We Know About Post-operative Prescribing? Variationsmentioning

confidence: 99%

“…Second, post-discharge prescribing practices need to be optimized to limit patients' risk of persistent postoperative use. The prevalence of excess prescribing and wide variations in prescribing practices indicate that there is substantial scope to improve current post-discharge prescribing practice (48,50). One approach to optimizing prescribing practices is ensuring that patients are discharged home with carefully constructed multimodal analgesia regimens (e.g., NSAID, Acetaminophen, Gabapentin), to minimize reliance upon opioids following discharge.…”

Section: Summing Up: a Call For Further Research And Actionmentioning

confidence: 99%

See 2 more Smart Citations

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

et al. 2020

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Section: What Do We Know About Post-operative Prescribing? Variationsmentioning

confidence: 99%

Section: What Do We Know About Post-operative Prescribing? Variationsmentioning

confidence: 99%

Section: Summing Up: a Call For Further Research And Actionmentioning

confidence: 99%

See 1 more Smart Citation

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

et al. 2020

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“…Alarmingly, a survey of 8888 high school seniors reported that 7% of them had used opioids for nonmedical uses in the past year, with 40% of those opioids being obtained from their own leftover prescriptions at home [2]. These facts have prompted the surgical community to examine opioid prescribing practices, with multiple studies finding excessive amounts of opioids prescribed to postoperative patients at the time of discharge [3,4]. Although pediatric surgeons have been found to prescribe less opioids than general surgeons for the same procedure [5], there are no standardized prescribing patterns and practices vary widely [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

et al. 2021

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Purpose Prescription drug monitoring programs (PDMPs) have been established to combat the opioid epidemic, but there is no data on their efficacy in children. We hypothesized that a statewide PDMP mandate would be associated with fewer opioid prescriptions in pediatric surgical patients. Methods Patients < 18 undergoing inguinal hernia repair, orchiopexy, orchiectomy, appendectomy, or cholecystectomy at a tertiary children’s hospital were included. The primary outcome, discharge opioid prescription, was compared for 10 months pre-PDMP (n = 158) to 10 months post-PDMP (n = 228). Interrupted time series analysis was performed to determine the effect of the PDMP on opioid prescribing. Results Over the 20-month study period, there was an overall decrease in the rate of opioid prescriptions per month (− 3.6% change, p < 0.001). On interrupted time series analysis, PDMP implementation was not associated with a significant decrease in the monthly rate of opioid prescriptions (1.27% change post-PDMP, p = 0.4). However, PDMP implementation was associated with a reduction in opioid prescriptions of greater than 5 days’ supply (− 2.7% per month, p = 0.03). Conclusion Opioid prescriptions declined in pediatric surgical patients over the study time period. State-wide PDMP implementation was associated with a reduction in postoperative opioid prescriptions of more than 5 days’ duration.

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“…Patients requiring orthopedic intervention are subject to opioid exposure as pain management in the setting of acute injury and post-operative period remain particularly opioid-centric [1,2]. While recent studies have focused on demographic factors impacting pediatric opioid exposure in orthopedics and other pediatric surgical fields [3][4][5][6], little study of perioperative orthopedic opioid exposure exists to the best of our knowledge. Increased understanding of nationwide opioid utilization patterns during these early phases of care is essential to grasping the entire scope of the pediatric opioid utilization and exposure in our country.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Opioid Exposure Patterns in Pediatric Anterior Cruciate Ligament Reconstruction: A Ten-Year Administrative Database Study

Anandarajan¹,

Williams²,

Markiewitz³

et al. 2021

Cureus

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Introduction: Variation in opioid exposure has been documented in many pediatric fields; however, little is currently known about the extent of these findings during the perioperative period. The purpose of this study was to examine perioperative opioid exposure on a national level among patients undergoing anterior cruciate ligament (ACL) reconstruction using an administrative database. Our aims were to assess the impact of hospitals and a variety of demographic factors on (1) the likelihood of perioperative opioid exposure and (2) the variability in relative opioid exposure. Methods: The Pediatric Health Information Systems Database (PHIS) was used to identify pediatric patients (≤ 18 years old) across 52 hospitals undergoing ACL reconstruction between January 2008 and December 2017. Administered opioids in morphine milligram equivalents were discretized into quintiles to represent relative opioid exposure (ROE). A hurdle generalized additive model was estimated to identify demographic factors predictive of (1) the receipt of any opioid medication and (2) the ROE among those receiving opioids. Results: Of the 19,821 patients meeting study inclusion criteria, 17,350 (88%) were administered opioid medications perioperatively. There was no temporal trend in perioperative opioid utilization or ROE over the study period. Patients in an inpatient (OR = 0.260 [0.221, 0.305]) or observation unit (OR = 0.349 [0.305, 0.401]) context were less likely to be administered opioids. Female patients (OR = 0.896 [0.813, 0.987]) were less likely to be administered opioids, while patients on commercial insurance had a higher ROE (OR = 1.09 [1.023, 1.161]). Patient age and hospital-level time trends predicted opioid administration and exposure (max p < 0.001). Discussion: Gender, age, surgical setting, hospital type, and insurance status, in part, predicted perioperative opioid exposure among pediatric patients undergoing ACL reconstruction surgery. Exposure has not declined in recent years and varies significantly between hospitals. Although this study primarily served to document demographic variability in perioperative opioid exposure in pediatric patients undergoing ACL reconstruction, the understanding of variability in perioperative opioid utilization and exposure rate could stand to be further explored.

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National variation in opioid prescribing after pediatric umbilical hernia repair

Cited by 35 publications

References 20 publications

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

Perioperative Opioid Exposure Patterns in Pediatric Anterior Cruciate Ligament Reconstruction: A Ten-Year Administrative Database Study

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