Specialty-specific reduction in opioid prescribing after common pediatric surgical operations

Horton, Joshua D.; Munawar, Suqrat; Feuvrier, Ariana; Corrigan, Corinne; Lockett, Mark; White, David R.; Cina, Robert A.

doi:10.1016/j.jpedsurg.2019.02.008

Cited by 16 publications

(14 citation statements)

References 15 publications

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“…Provider-level practices likely contribute to opioid prescribing trends over time and represent a focus area for quality improvement. Several other groups have reported success with reducing opioid prescriptions via interventions including standardized opioid prescription protocols [12], educational interventions aimed at providers [13,14], and reducing the default number of pills pre-specified in the EMR [16]. A no-opioid pathway following laparoscopic appendectomy has been employed with success at some institutions [21].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Nationwide efforts have been made to address these problems. Educational interventions have been implemented at a number of institutions with resulting decrease in opioid prescriptions to postoperative patients [12][13][14]. This has not been shown to result in worse pain control in pediatric surgical patients [15].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…A strict limit of 20 doses was placed on this medication by the order set, this number being based on our previous findings with postoperative pain management needs in children after tonsillectomy. 8,9 See Supplemental Tables S1 to S3 in the online version of the article for weight-based dosing tables for each of these medications. Finally, it is our practice to prescribe a single postoperative day 3 dose of 0.5 mg/kg dexamethasone after tonsillectomy, and the order set was designed to automatically do so for all patients.…”

Section: Methodsmentioning

confidence: 99%

Effect of a Standardized Electronic Medical Record Order Set on Opioid Prescribing after Tonsillectomy

Horton

Corrigan

Patel

et al. 2020

Otolaryngol.--head neck surg.

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Objective Approximately 5% of children develop new persistent opioid use after tonsillectomy. Critical review of our prescribing practices revealed inconsistent and excessive opioid prescribing after this procedure in children. We sought to improve our practice by using a standardized electronic medical record (EMR)–based order set. Methods Retrospective chart review of outpatient tonsillectomy performed before and after institution of an EMR intervention with comparison of opioid and nonopioid analgesic (NOA) prescription characteristics as well as outcomes including hemorrhage and readmission. Results Analysis of 276 preorder set and 128 post–order set tonsillectomies revealed a significant increase in NOA utilization following initiation of the order set and a significant reduction in doses of opioid prescribed. Due to a change to a stronger opioid in the order set, morphine dose equivalents (MDEs) prescribed were not decreased in the post–order set cohort. Variability between prescriptions and providers was significantly decreased in the post–order set group in terms of doses and MDEs, and dangerously high outlier prescriptions were eliminated. No differences in pain control, postoperative hemorrhage, presentation to the emergency department, or readmission were identified. Discussion An EMR-based intervention improved the quality and safety of posttonsillectomy opioid prescribing at our institution. Moving forward, this order set provides a platform with which to titrate opioid prescriptions and NOA to optimal pain control and safety levels. Implications for Practice A standardized EMR-based order set can improve the quality of opioid prescribing after tonsillectomy.

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“…Opioids should be considered from the outset in events of severe pain or in events of failure of paracetamol and ibuprofen. Recent studies and guidelines on post-operative analgesia consider pain management without opioids as much as possible in many situations [ 39 , 40 ]. Consensus and interdisciplinary collaborations seem necessary for the relevance and safe and appropriate use of opioids in children.…”

Section: Discussionmentioning

confidence: 99%

Opioid Analgesic Prescription in French Children: A National Population-Based Study

Choufi

Mounier

Merlin

et al. 2021

IJERPH

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Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children.

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Specialty-specific reduction in opioid prescribing after common pediatric surgical operations

Cited by 16 publications

References 15 publications

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

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

Effect of a Standardized Electronic Medical Record Order Set on Opioid Prescribing after Tonsillectomy

Opioid Analgesic Prescription in French Children: A National Population-Based Study

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