Race and socioeconomic determinants of opioid use and disposal following pediatric surgery

Adam C. Adler; Brittany E. Bryant; David Baszynski; Andrew Lee; Eduardo Medellin; Brian H. Nathanson; Arvind Chandrakantan

doi:10.5055/jom.0821

Authors

Adam C. Adler, MS, MD, FAAP, FASE https://orcid.org/0000-0002-6518-1549
Brittany E. Bryant, MD
David Baszynski, PharmD, BCPS, RPh
Andrew Lee, MPH
Eduardo Medellin, BS
Brian H. Nathanson, PhD, DSHS
Arvind Chandrakantan, MD, MBA, FAAP, FASA

DOI:

https://doi.org/10.5055/jom.0821

Keywords:

opioids, pediatrics, prescribing, utilization, disposal

Abstract

Background: Opioids are a mainstay in treating acute post-surgical pain although there are limited data on post-discharge use.

Objectives: To assess post-operative opioid usage in children undergoing outpatient pediatric surgical procedures and provider variability in the number of doses prescribed by procedure.

Methods: This cohort study included parents of children who were prescribed opioids following outpatient pediatric surgical procedures at Texas Children's Hospital from July 2019 to July 2020. Subjects participated in an opioid takeback program with an accompanying telephone survey to determine opioid utilization. Reported opioid usage included the following: none (0 percent), some (>0 percent but <100 percent), and all (100 percent). Provider prescribing patterns were stratified by doses and surgical intervention.

Results: Parents of 423 patients received follow-up calls, of which 350 (82.7 percent) reported use of some to all opioids and 73 (17.3 percent) reported using none. In the group reporting use of all opioids (n = 140 [33.1 percent]), parents were more likely to be single, have Medicaid, and report lower education levels when compared with parents reporting some or no opioid use. The number of opioids prescribed was not associated with the amount used (p = 0.51). The number of doses varied widely within each surgical procedure: The median number of doses prescribed ranged from 6 to 15 with some patients prescribed more than twice the median given the same procedure.

Conclusion: This study suggests that opioids are indicated for acute post-surgical pain in children although select patient and parental factors are associated with the extent of usage. This study also highlights significant variability in prescribed doses for similar procedures and may indicate both overprescribing and underprescribing by physicians.

Author Biographies

Adam C. Adler, MS, MD, FAAP, FASE

Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

Brittany E. Bryant, MD

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota

David Baszynski, PharmD, BCPS, RPh

Department of Pharmacy, Mayo Clinic; Department of Pharmacy, Methodist Hospital, Rochester, Minnesota

Andrew Lee, MPH

Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas

Eduardo Medellin, BS

Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas

Brian H. Nathanson, PhD, DSHS

OptiStatim, LLC, Longmeadow, Massachusetts

Arvind Chandrakantan, MD, MBA, FAAP, FASA

Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

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