SLR - April 2021 - Nicholas L. Varakin

Refilling Opioid Prescriptions after Pediatric Orthopaedic Surgery: An Analysis of Incidence and Risk Factors

Reference: Meza BC, Swarup I, Woodard T, Cazzulino A, Talwar D, Shah AS. Refilling opioid prescriptions after pediatric orthopaedic surgery: An analysis of incidence and risk factors. J Pediatr Orthop. 2021 Mar 1;41(3):e291-e295. doi: 10.1097/BPO.0000000000001736.

Level of Evidence: Level III 

Scientific Literature Review

Reviewed By: Nicholas L. Varakin, DPM
Residency Program: Temple University Hospital, Philadelphia, PA

Podiatric Relevance: Opioid medications are commonly prescribed post-operatively for pain control. It is important for surgeons to practice good opioid stewardship, especially when dealing with a pediatric population who may have different requirements for pain control. The authors attempted to describe the incidence of, and risk factors for, patients who required opioid refills after pediatric orthopaedic surgery.

Methods: This was a case controlled retrospective study from a single tertiary care hospital for children. The study included 1413 patients from ages 0 to 18 who underwent orthopedic surgery and were prescribed opioids on discharge. Prescription Drug Monitoring Program databases were queried to look for additional prescription refills within six months post-operatively. The primary outcome was defined as “need for further refill”. Surgeries were further categorized by nature of surgery and anatomic location. Patients who did refill were compared with those who did not to identify any risk factors predisposing for additional opioid requirements. 

Results: Of the patients included in the study, 60.8 percent were male with a median age of 12.4 years. Fracture surgery was the most common type of operation reviewed and 99.4 percent of patients were prescribed Oxycodone upon discharge. Thirty-one patients (2.2 percent) obtained refills following the initial prescription. They noted that patients who requested refills were more likely to have received Hydromorphone (OR 3.04) or Methadone (38.14) while in the hospital and/or received significantly more opioids during their inpatient recovery from surgery. The amount of opioids prescribed at discharge was similar for all cases. 

Conclusions: Children are susceptible to forming opioid use disorders which can affect them far into adulthood. Good stewardship of opioid use in children is critically important. Patients should be watched carefully, especially those that required higher than normal opioid use in the hospital. More multimodal pain management strategies should be employed in efforts to reduce need for and dependence on opioid based medications. Further studies are needed to examine opioid use post-operatively in the pediatric population as well as studies focusing on multimodal approaches to pain management in children. 

Educational Opportunities