O2073: Targeted Opioid Prescription Guidelines for the Post-operative Pediatric Orthopaedic Patient

Background: Amid a national opioid epidemic, it is essential to review the necessity of opioid prescriptions. Research in adults has demonstrated that patients frequently do not use their entire opioid prescription after surgery. Similar data is available in children, though the scope is much more limited. The purpose of this study was to investigate the prescription volume and utilization rate of opioids prescribed to pediatric orthopaedic surgery patients at our institution.

Methods: Children presenting to our academic Level 1 trauma center or orthopaedic ambulatory surgical center, from May 24, 2021, to December 13, 2021, requiring surgical management or operating room intervention were identified by the study team. Patients ages 0-18 years were eligible for inclusion. Patients 18 or older or those presenting for spinal surgery were excluded. Patient demographics and opioid prescription volume were recorded. Parents and guardians were surveyed by phone on post-operative days (POD) 10-15, assessing pain level, prescription opioid use, and plans for any remaining opioid doses. Wilcoxon rank-sum test, Independent t-test, and Pearson correlation were utilized for analysis of continuous variables. Multivariable logistic regression was used to control for patient demographic variables while analyzing opioid usage relationships. A p-value < 0.05 was considered statistically significant. Analyses were performed using IPython Notebook, Stata/SE, and Microsoft Excel.

Results: Prescription volume information was collected for 280 eligible patients who obtained care during the study period. 102 patient’s parents or guardians participated in a survey on opioid utilization, pain levels, and drug disposal (Group 1). 178 patients were not able to be contacted, and thus only contributed prescription volume information (Group 2). Patients with upper extremity (UE) fractures on average received significantly fewer doses of opioids at discharge compared to other procedure types (p=0.036). The number of post-operative opioid doses prescribed was positively correlated with increased BMI (R2=0.647, p< 0.001). The mean opioid utilization rate among Group 1 patients prescribed 1 or more opioid doses was 21.73%. About half (50.63%) of patients prescribed opioids at discharge used zero doses. 96.20% of patients used opioids for 5 days or less. 616.50 doses were reported unused, and most families had not disposed of excess mediation by POD 10.

Conclusion: This study expands upon previous findings of low opioid prescription utilization in pediatric orthopaedic surgery patients. A group of patients undergoing a wide range of orthopaedic procedures reported using only 21.73% of prescribed doses, consistent with recent literature on pediatric fracture and sports knee procedure patients. There is significant variation of opioid use among procedure types, suggesting the potential for procedure-specific prescribing guidelines. Additional patient and prescriber education is needed to ensure safe opioid disposal, reducing potential for misuse and diversion.