Opioid prescription and postoperative outcomes in pediatric patients

• Published in: The Laryngoscope 2019-06, Vol.129 (6), p.1477-1481
• Main Authors: Whelan, Rachel L., McCoy, Jennifer, Mirson, Leonid, Chi, David H.
• Format: Article
• Language: English
• Subjects: Consent; Narcotics; opioid prescription; Pain; pediatric opioid; Pediatrics; postoperative opioid; Postoperative pain; Postoperative period; tonsillectomy pain
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.27614

Objectives/Hypothesis To determine if the amount of opioid prescribed and postoperative outcomes after adenotonsillectomy changed following implementation of mandated opioid consent forms. Study Design Retrospective cohort study. Methods Patients undergoing adenotonsillectomy 6 months before and after implementation of mandated opioid consent forms at a tertiary‐care pediatric hospital were studied. Demographics, operative data, weight‐based opioid dosage, and postoperative outcome measures, including nursing calls, emergency department (ED) visits, hospital readmission, and bleed rates, were collected and analyzed. Results Of 300 patients, opioid prescription was provided for 211 patients (70.3%), 112 preconsent (74.7%) and 99 postconsent (66.0%). Mean (standard deviation) total opioid prescribed (milligrams/kilogram) was significantly higher preconsent 4.8 (5.6) than postconsent 3.2 (4.7), (P = .003). There were no differences between number of nursing calls (P = .134) or ED visits (P = .083). Interestingly, preconsent patients had more hospital readmission for pain/dehydration (odds ratio OR: 368, P = .016) and bleeding concerns (OR: 244, P = .003). Conclusions A mandated consent form prior to opioid prescription was associated with decreased overall opioid prescription without resultant increase in postoperative complications in pediatric patients. These data provide support for minimizing opioid prescription on a systems‐based level. Level of Evidence 4 Laryngoscope, 129:1477–1481, 2019