Inconsistency in Opioid Prescribing Practices After Pediatric Ambulatory Hernia Surgery

• Published in: The Journal of surgical research 2019-09, Vol.241, p.57-62
• Main Authors: Denning, Naomi-Liza, Kvasnovsky, Charlotte, Golden, Jamie M., Rich, Barrie S., Lipskar, Aaron M.
• Format: Article
• Language: English
• Subjects: Adolescent; Ambulatory surgery; Ambulatory Surgical Procedures - adverse effects; Analgesics, Opioid - therapeutic use; Child; Child, Preschool; Drug Prescriptions - statistics & numerical data; Female; Herniorrhaphy - adverse effects; Hospitals, Pediatric - statistics & numerical data; Humans; Infant; Male; Narcotic prescribing; Opioid Epidemic - etiology; Opioid Epidemic - prevention & control; Opioids; Orchiopexy - adverse effects; Outpatient Clinics, Hospital - statistics & numerical data; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pediatric surgery; Pediatrics; Practice patterns; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Tertiary Care Centers - statistics & numerical data; Testicular Hydrocele - surgery; United States - epidemiology
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.03.043

Nonmedical opioid use is a major public health problem. There is little standardization in opioid-prescribing practices for pediatric ambulatory surgery, which can result in patients being prescribed large quantities of opioids. We have evaluated the variability in postoperative pain medication given to pediatric patients following routine ambulatory pediatric surgical procedures. Following IRB approval, pediatric patients undergoing umbilical hernia repair, inguinal hernia repair, hydrocelectomy, and orchiopexy from 2/1/2017 to 2/1/2018 at our tertiary care children's hospital were retrospectively reviewed. Data collected include operation, surgeon, resident or fellow involvement, utilization of preoperative analgesia, opioid prescription on discharge, and patient follow-up. Of 329 patients identified, opioids were prescribed on discharge to 37.4% of patients (66.3% of umbilical hernia repairs, 20.6% of laparoscopic inguinal hernia repairs, and 33.3% of open inguinal hernia repairs [including hydrocelectomies and orchiopexies]). For each procedure, there was large intrasurgeon and intersurgeon variability in the number of opioid doses prescribed. Opioid prescription ranged from 0 to 33 doses for umbilical hernia repairs, 0 to 24 doses for laparoscopic inguinal repairs, and 0 to 20 doses prescribed for open inguinal repairs, hydrocelectomies, and orchiopexies. Pediatric surgical fellows were less likely to discharge a patient with an opioid prescription than surgical resident prescribers (P