Opioid prescribing practices for pediatric tonsillectomy before and after policy interventions

Abstract

Objective This study's purpose was to investigate opioid prescribing practices after pediatric tonsillectomy in the year before and year after implementation of statewide policy interventions in Vermont. Methods We reviewed charts of consecutive patients less than 18 years old that underwent tonsillectomy or adenotonsillectomy at a single tertiary academic medical center 1 year before (July 2016–June 2017) and 1 year after (July 2017–June 2018) implementation of policy interventions targeted at opioid prescribing. Data collected included demographics, procedure performed, indication, complications, medical comorbidities, opioid prescribing practices (medication, dose, morphine milliequivalents, and postdischarge opioid prescriptions), and postoperative telephone calls and emergency department (ED) visits. Results Tonsillectomy or adenotonsillectomy was performed in 360 consecutive patients (185 in the pre‐policy year and 175 in the post‐policy year). Those receiving an opioid prescription in the pre‐ compared to post‐policy year was 49.7% versus 15.4% (p < .001). Of patients 6 years and older, 95.8% in the pre‐policy year compared to 25.2% in the post‐policy year received a postoperative opioid (p < .001). There was no difference in pain‐related office phone calls, postdischarge opioid prescriptions or ED visits between the two groups. There was no difference in morphine milligram equivalent prescribed in the pre‐ and post‐groups. Conclusion Implementation of statewide policy interventions can have a substantial impact on opioid prescribing practices in the pediatric tonsillectomy population without an increase in office phone calls, postdischarge opioid prescriptions, and ED visits. Level of Evidence 4

Impact of state legislation and institutional protocols on opioid prescribing practices following pediatric tonsillectomy

“… 35 Finally, the most recent publication compared 360 pediatric tonsillectomy patients 1 year before and after legislation requiring signed opioid consents in the state of Vermont. 36 This study reports large decreases in the percentage of patients receiving an opioid prescription (50% pre vs. 15% post, p < .001).…”

“…The second study, from West Virginia, which enacted a law in 2018 limiting the quantity of opioids prescribed, retrospectively reviewed over 10,000 pediatric trauma patients and showed more modest but still statistically significant decreases in the percentage of patients receiving a prescription (46%–37%, p < .001) 35 . Finally, the most recent publication compared 360 pediatric tonsillectomy patients 1 year before and after legislation requiring signed opioid consents in the state of Vermont 36 . This study reports large decreases in the percentage of patients receiving an opioid prescription (50% pre vs. 15% post, p < .001).…”

“…7,26,27 Our study highlights three new findings. In the pediatric literature, three recent investigations into effects of legislative policies on post-operative opioid prescribing in children [34][35][36] ; however, none of these studies address the effect of legislation on variation in prescriptions. The first, published in 2021, retrospectively analyzed over 4300 pediatric urology patients in the state of Pennsylvania in which opioid consents have been required for minors since 2016.…”