SLR - March 2020 - Katie Pettibone

Prescription vs. Consumption: Opioid Over Prescription to Children After Common Surgical Procedures    

Reference: Pruitt LCC, Swords DS, Russell KW, Rollins MD, Skarda DE. Prescription vs. Consumption: Opioid Over Prescription to Children After Common Surgical Procedures. J Pediatr Surg. 2019 Nov; 54(11):2195-2199.     

Scientific Literature Review            

Reviewed By: Katie Pettibone, DPM
Residency Program: Kaiser Permanente North Bay Consortium – Vallejo, CA

Podiatric Relevance: Postoperative pain management in the midst of the current opioid epidemic requires consideration as surgeons strive to achieve an evidence-based multimodal approach to postoperative pain management. This is an especially important consideration in the pediatric population. It is critical to achieve adequate postoperative pain control while not over prescribing opioids and thus further contributing to the present epidemic. This study surveys pediatric patients postoperatively to assess how well their pain was controlled and what percentage of the opioids prescribed were ultimately consumed. The study strives to identify an excess of postoperative opioid prescription in this uniquely vulnerable pediatric population.

Methods: In this level III evidence study, the authors surveyed 277 pediatric patients ages 10-18 across five states and 23 hospitals. The electronic survey sent two weeks postoperatively ascertained the number of opioid tablets patients were prescribed relative to what they had actually consumed. 

Additionally, the survey asked patients to identify how well their pain was controlled, and state what they had done with the unused tablets. The survey polled patients who had undergone a wide range of procedures including general surgery, otolaryngology, and orthopedic surgery. Sixteen of the patients had undergone ORIF of the foot or ankle.  

Results: Of the 277 patients who responded to the survey, opioid tablets prescribed exceeded opioid tablets consumed for all procedure types with statistical significance. In the majority of procedures, the number of opioid tablets prescribed was twice that of what was ultimately consumed. Patients were asked to state whether or not their pain was well controlled postoperatively, and all foot and ankle ORIF patients endorsed adequate pain control. The majority of patients (64 percent) surveyed kept the unused opioid tablets in their home and many reported they did not know how to dispose of the unused tablets.

Conclusions: This study demonstrates that pediatric patients achieved good postoperative pain control after a wide variety of procedures despite consuming only a fraction of the opioid tablets they were prescribed. In the majority of procedures, patients used less than half of the tablets they were prescribed.

This study demonstrates a clear opportunity for improvement in postoperative pain management. The results identify cause for decreasing postoperative opioid tablet prescription in the pediatric patient to avoid contributing to leftover opioid tablets in the home. Although this study captured a wide range of surgical patients, evidence-based practice could be further improved by honing in on the pediatric foot and ankle patient specifically. The study is also limited by survey response rate, which was 26 percent of a pool of 3935 patients.      

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