Faculty Collaboration Database

A Societies for Pediatric Urology survey of opioid prescribing practices after ambulatory pediatric urology procedures. J Pediatr Urol 2019 Oct;15(5):451-456

Date

06/05/2019

Pubmed ID

31160172

DOI

10.1016/j.jpurol.2019.04.025

Scopus ID

2-s2.0-85066309092 (requires institutional sign-in at Scopus site)   23 Citations

Abstract

INTRODUCTION: Opioid dependence and abuse has been declared a national public health emergency, and overprescribing of opioids after surgery has been identified as a driving factor. To date, opioid prescribing after pediatric urology ambulatory surgery has not been well-described.

OBJECTIVE: The study's objective was to assess pediatric urologists' practices in prescribing opioids for routine ambulatory procedures.

STUDY DESIGN: A 23-question survey was created, including eight case vignettes describing routine procedures (orchiopexy, hydrocele repair, circumcision) across three age groups (8 months, 3 years, 13 years). Multiple choice questions asked about typical opioid type and duration for each case. Respondent attitudes and practice types were also evaluated. The survey was administered through the Societies for Pediatric Urology.

RESULTS: Of the 102 respondents, 48% reported prescribing postoperative opioids for all cases described (Figure 1). Fourteen percent reported prescribing no opioids for all cases. Longer prescription duration was associated with older age (p = 0.003). Acetaminophen-hydrocodone was prescribed most commonly, while a few respondents reported prescribing acetaminophen-codeine. North Central and Southeastern respondents were more likely to prescribe opioids for all cases described (p = 0.003). The majority of respondents work in academic settings and had >10 years in practice. Only 16% believe that their patients take the majority of opioids prescribed, while only 35% provide education to their patients on proper disposal.

DISCUSSION: There is significant variability in reported opioid prescribing practices after ambulatory procedures amongst pediatric urologists. Only 16% of respondents believe that patients take the majority of opioids prescribed, and only 14% reported never prescribing opioids for these procedures. There is an opportunity for guidelines and standardization of care for postoperative analgesia in this patient population. Given that overprescribing can lead to abuse and misuse, further work needs to be done to establish postoperative analgesia needs and to educate providers and families on proper prescribing and disposal.

CONCLUSION: Pediatric urologists report prescribing opioids frequently after routine ambulatory procedures in infants, children, and adolescents despite believing that patients do not take the majority of the prescribed medication.

Author List

Ahn JJ, Ellison JS, Merguerian PA

Author

Jonathan Scott Ellison MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Ambulatory Surgical Procedures
Analgesics, Opioid
Child, Preschool
Circumcision, Male
Drug Prescriptions
Health Care Surveys
Humans
Infant
Male
Orchiopexy
Pain, Postoperative
Pediatrics
Practice Patterns, Physicians'
Societies, Medical
Testicular Hydrocele
Urologic Surgical Procedures
Urology