Evaluating and Changing Postoperative Opioid Prescribing After Routine Pediatric Surgery
With continued concern regarding a national opioid epidemic, there is greater focus on physician narcotic prescribing practices as a potential contributing factor to increasing opioid misuse. In an effort to evaluate this potential among pediatric surgeons we designed a two phased study including baseline evaluation and intervention. Our objectives were to assess potential variations in opioid prescribing practices amongst pediatric surgeons after routine surgical procedures, complete an educational intervention for the surgeons, and evaluate the effectiveness of such an intervention in reducing opioid prescribing. We initially performed a retrospective review of children ( 7 days, or a postoperative LOS > 3 days were excluded. Data collected included patient demographics, operating surgeon, opioid prescription and dosages, and LOS. Statistical analysis was performed using Chi-square, Fisher’s Exact, Mann Whitney test, and univariate and multivariable logistic regression analyses. Initial review of 5,458 children operated on by 23 pediatric surgeons, demonstrated that 36% (n=1973) of patients received an opioid prescription at discharge. Univariate analysis showed opioid prescription rate to vary by patient age, patient gender, operating surgeon, and surgeon experience (all p 3 days were excluded. Data collected included patient demographics, operating surgeon, opioid prescription and dosages, and LOS. Statistical analysis was performed using Chi-square, Fisher’s Exact, Mann Whitney test, and univariate and multivariable logistic regression analyses. Initial review of 5,458 children operated on by 23 pediatric surgeons, demonstrated that 36% (n=1973) of patients received an opioid prescription at discharge. Univariate analysis showed opioid prescription rate to vary by patient age, patient gender, operating surgeon, and surgeon experience (all p0.05) except in the case of one surgeon whose patient’s characteristics differed significantly. Based on these results we concluded that there is significant variation in opioid prescribing patterns among pediatric surgeons after routine operations, and the operating surgeon is the single consistent influence on whether or not opioids are prescribed. However, a single group educational session concerning opioid prescribing practices may not lead to clinically significant changes for some pediatric surgeons.
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