Opioid Use Among Pediatric Patients After Surgery

Written by Alex Chen, MD

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In opioid naïve patients 13-21 years of age, persistent opioid use was found in 4.8% of the post-surgical group vs 0.1% of those in the non-surgical group. Independent risk factors included older age, female sex, diagnoses of substance use disorder and chronic pain.

Why does this matter?
Mounting evidence suggests that adults have an increased risk of long-term opioid use following even one narcotic prescription for simple surgeries and acute pain in the emergency department.  But what about children?  This is the first study to examine persistent opioid use among adolescents and young adults after surgery.

One prescription begets another?
This was a retrospective cohort study in which the primary outcome looked at persistent opioid use after surgery (≥1 additional opioid prescription filled between 90 and 180d post-surgery). They compared opioid naïve patients in a post-surgical group to a random sample of non-surgical patients. In terms of the characteristics of the study population, they identified older age (AOR 1.07, CI 1.05-1.08), female sex (1.22, 1.14-1.31), substance use disorder (1.41, 1.12-1.77), chronic pain diagnoses (1.48, 1.33-1.66), and opioid prescription 30d prior to the procedure (1.26, 1.17-1.36) as risk factors for persistent opioid use. Their primary outcome examines the number of prescriptions filled; however, it does not factor in the amount prescribed and amount actually consumed.

The procedures they identified that had the highest adjusted odds ratio for prolonged opioid refills were cholecystectomy (AOR 1.13, CI 1-1.26) and colectomy (AOR 2.33, CI 1.01-5.34).  This is in stark contrast to surgeries that were prescribed the highest amount of oral morphine equivalents (OME), such as pectus repair and posterior arthrodesis which did not have statistically significant increases in prolonged opioid refills.  I wonder if this is because we perceive these procedures as more painful and treat them aggressively, or because we are utilizing an inappropriate modality for pain management in certain patient populations.  It may very well be a combination of both, and this is something that we need to consider when treating the post-surgical patient.

Source
Persistent Opioid Use Among Pediatric Patients After Surgery.  Pediatrics. 2018 Jan;141(1). pii: e20172439. doi: 10.1542/peds.2017-2439. Epub 2017 Dec 4

Reviewed by Clay Smith, MD and Thomas Davis, MD.

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