The impact of post-operative opioid guidelines on prescribing behaviors in the pediatric population
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ORIGINAL ARTICLE
The impact of post‑operative opioid guidelines on prescribing behaviors in the pediatric population Ahmer Irfan1 · Laura Y. Martin2 · Joseph Canner1 · Joanna Etra1 · Andres J. Gonzalez Salazar1 · Heidi N. Overton1 · Eric B. Jelin3 Accepted: 1 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Opioid misuse continues to be a major source of morbidity and mortality in the US, in both the adult and pediatric populations. Post-operative opioid prescriptions are often the first exposure children have to opioids and increases their risk of chronic use. There is significant variation in the number of opioids following identical procedures and measures have been taken within the adult population to limit this. However, specific post-operative opioid prescription guidelines are not present in the pediatric population. Methods Seven common pediatric surgery procedures were selected for inclusion. The recommended number of opioid doses following each procedure was determined by a multi-disciplinary expert panel. All surgery residents were sent an initial survey to determine the number of opioids they would prescribe for each procedure. They were then shown the guidelines and the survey repeated to determine changes in response. Results 35 and 27 general surgery residents took part in and pre- and post-educational surveys respectively. In all procedures, there was a decrease in the mean number of post-operative opioids prescribed. In addition, there was an increase in the number of residents who prescribed within the guidelines and a decrease in the number who overprescribed post-operative opioids. Conclusion Pediatric postoperative opioid prescribing guidelines derived from expert opinion increase resident compliance with appropriate dosing; this has the potential to decrease the classic problem of general surgery residents accustomed to treating adults overprescribing opioids to children. These results are promising, and we aim to expand on this work and incorporate these guidelines into our clinical practice. Level of evidence III/IV. Keywords Opioid · Narcotic · Pediatric · Prescription · Outpatient surgery
Introduction The number of deaths from drug overdose continues to rise in the US, with over 70,000 drug overdose-related deaths in 2017, a 9.6% increase from the age-adjusted rate in the * Eric B. Jelin [email protected] 1
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
2
Department of Pediatric Surgery, Vanderbilt Children’s Hospital, Nashville, TN, USA
3
Department of Surgery, Division of Pediatric Surgery, Johns Hopkins School of Medicine, Johns Hopkins Children’s Center, 1800 Orleans St, Baltimore, MD 21287, USA
previous year [1]. Over half of the drug overdose deaths in 2017 were attributed to opioids, with 17,000 caused by prescription opioids [2]. While the majority of these deaths have been in adult patients, this trend is also applicable to the pediatric population. This can be demonstrated by an increase in th
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