The influence of guidelines on opioid prescribing practices after pediatric anterior cruciate ligament reconstruction

Abstract

Objective: To report opioid prescription patterns after pediatric anterior cruciate ligament reconstruction (ACLR) and identify if the implementation of the opioid prescribing guidelines (OPGs) modified these patterns.

Design: A retrospective chart review.

Setting: Level 1 Pediatric Trauma Center.

Patients: Pediatric patients who underwent primary ACLR at a single pediatric

hospital system between the years 2016 and 2018 were included. Patients were excluded if they did not receive an opioid prescription from an orthopedic provider at the time of discharge or if they underwent an additional operative procedure within 90 days of the index surgery. Eighty-six patients met the criteria for a retrospective review.

Interventions: Opioid prescriptions were converted into morphine equivalent doses (MEDs) for standardization.

Main outcome measure: The average MED prescribed at the time of discharge and during follow-up visits for pediatric patients undergoing ACLR.

Results: Patient's age was the only independent variable that had a significant relationship with discharge MED (p = 0.002) and predicted that MED at discharge increases by 20.7 units [confidence interval = 12.3-29.1] for each increasing year in patient age. Discharge MED prescribed after implementation of the OPG was found to be significantly less than discharge MED prescribed prior to the OPG through Wilcoxon rank-sum test (p < 0.001).

Conclusions: Implementation of the OPG in Ohio led to a significant reduction in opioid doses prescribed to patients at all time points within 90 days of ACLR. However, these guidelines also led to a significant increase in the likelihood that post-OPG patients would receive an additional opioid prescription during follow-up within 90 days of surgery.