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Whelan RL, McCoy JL, Mirson L, Maguire RC, Jabbour N, Simons JP, Dohar JE, Kitsko DJ, Stapleton AL, Tobey ABJ, Alper CM, Shaffer AD, Bennett ZR, Chi DH. Opioid Analgesia Following Pediatric Adenotonsillectomy: A Randomized Clinical Trial. Otolaryngol Head Neck Surg 2025. [PMID: 40396501 DOI: 10.1002/ohn.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 02/28/2025] [Accepted: 04/12/2025] [Indexed: 05/22/2025]
Abstract
OBJECTIVE To compare the safety and efficacy of nonopioid versus opioid pain management following adenotonsillectomy (AT) among pediatric patients. STUDY DESIGN An open-label randomized controlled trial. SETTING Tertiary care children's hospital. METHODS Patients aged 3 to 17 years undergoing AT were eligible. Participants were randomly assigned to receive either acetaminophen and ibuprofen (nonopioid group) or acetaminophen, ibuprofen, and oxycodone (opioid group). Pain scores and prevalence of emergency department (ED) visits, hospital readmission, and posttonsillectomy hemorrhage (PTH) were compared between groups. RESULTS From January 2019 to March 2020, 267 patients were enrolled and randomly assigned; 144 completed a postoperative pain diary. Of the 144, 69 (48%) patients received an opioid prescription, and 75 (52%) did not. Mean pain scores before (opioid: 5.78, 95% CI: 5.29-6.27 vs nonopioid: 5.66, 95% CI: 5.20-6.12) and after (opioid: 2.33, 95% CI: 1.89-2.78 vs nonopioid: 2.24, 95% CI: 1.82-2.66) analgesics were not significantly different between opioid and nonopioid groups. Although 7/75 (9%) from the nonopioid group crossed over and requested opioids, only 43/69 (62%) randomly assigned to receive opioid prescription consumed opioids. The rate of opioid consumption increased with increasing age: 18/71 (25%) patients aged 3 to 7 years, 22/57 (39%) 8 to 12 years, and 10/16 (63%) 13 to 17 years, P = .015. Differences in ED visits, hospital readmissions, and PTH between opioid and nonopioid groups were not significant. CONCLUSION Many children do not require opioid analgesics following AT, particularly children less than 8 years of age. Postoperative pain scores and outcomes were similar in opioid versus nonopioid groups. Opioid prescriptions should be limited or avoided altogether after pediatric AT. TRIAL REGISTRATION Title: Nonopioids for analgesia after adenotonsillectomy in children; ID: NCT03618823, Clinicaltrials.gov.
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Affiliation(s)
- Rachel L Whelan
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer L McCoy
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Leonid Mirson
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raymond C Maguire
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Noel Jabbour
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P Simons
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joseph E Dohar
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dennis J Kitsko
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amanda L Stapleton
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Allison B J Tobey
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cuneyt M Alper
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Zachary R Bennett
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David H Chi
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Hathi K, Francis G, Douglas J, Nemeth E, Hong P. Ninety-Day Emergency Department Rebound Following Adult Tonsillectomy: A Retrospective Cohort Study. J Otolaryngol Head Neck Surg 2025; 54:19160216251333350. [PMID: 40366097 PMCID: PMC12078963 DOI: 10.1177/19160216251333350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 02/22/2025] [Indexed: 05/15/2025] Open
Abstract
ImportancePost-tonsillectomy complications often present in emergency departments (EDs). Reducing postoperative ED visits is one strategy to relieve the strain on healthcare systems and patients.ObjectiveTo assess the rate and reason for ED visits within 90-days post-discharge from adult tonsillectomy.DesignRetrospective cohort study.SettingNova Scotia, Canada.ParticipantsAll adult patients (≥16 years old) with a Nova Scotia Healthcare card who underwent a tonsillectomy in Nova Scotia, Central Zone from April 1, 2016 to March 31, 2022, and had an ED visit anywhere in Nova Scotia from April 1, 2016 to June 30, 2022, to allow a 90-days post-discharge window.MethodsRetrospective chart review utilizing administrative datasets for province-wide ED visits within 90-days post-discharge from an adult tonsillectomy. The patients' first ED visit postoperation was analyzed.ResultsOverall, 356 adult patients underwent tonsillectomy, of which 129 (36.2%) presented to the ED within 90 days. Of these, 99 were related to the tonsillectomy, resulting in a surgery-specific ED rebound rate of 27.8%. Most surgical ED visits (84/99, 84.8%) occurred within 7 days, most commonly for bleeding (47/99, 47.5%) and pain (36/99, 36.4%). Of the surgical visits, 26/99 (26.3%) were admitted, with 22/26 (84.6%) for bleeding. Of the surgical visits not related to bleeding, 48/52 (92.3%) were discharged home or left without being seen, which suggests 48/99 (48.5%) surgical ED visits may be preventable.ConclusionThe ED rebound rate for visits related to the tonsillectomy was 27.8% in our population. Given the potentially severe consequences of post-tonsillectomy bleeding, a high ED visit rate may be necessary. However, optimization of postoperative pain control along with greater access to urgent outpatient otolaryngology and primary care resources may reduce the burden of ED visits. This data adds to recent literature suggesting a higher rate of healthcare usage post-adult tonsillectomy.
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Affiliation(s)
- Kalpesh Hathi
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Gizelle Francis
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - JoAnne Douglas
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Evan Nemeth
- Performance and Analytics, Quality and System Performance, Nova Scotia Health, Halifax, NS, Canada
| | - Paul Hong
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Schneuer FJ, Bell KJL, Dalton C, Elshaug A, Nassar N. Adenotonsillectomy and adenoidectomy in children: The impact of timing of surgery and post-operative outcomes. J Paediatr Child Health 2022; 58:1608-1615. [PMID: 35657070 PMCID: PMC9543311 DOI: 10.1111/jpc.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/28/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
AIM To investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications. METHODS We included all children aged <16 years undergoing ADT (tonsillectomy ± adenoidectomy) or AD in New South Wales, Australia, 2008-2017. Health information was obtained from administrative hospitalisation data. Rates of post-operative complications and reoperation were evaluated using generalised estimating equations and Kaplan-Meier methods, respectively. RESULTS Out of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008-2017 (ADT: 68-79 per 10 000 children; AD: 25-34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post-operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0-1 years, lowest for those 2-5 years and increased with age thereafter. Three-year reoperation rates for children aged 0-1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12-13 years. CONCLUSIONS ADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post-operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms.
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Affiliation(s)
- Francisco J Schneuer
- The Children's Hospital at Westmead Clinical SchoolFaculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia
| | - Katy JL Bell
- Sydney School of Public HealthFaculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia
| | | | - Adam Elshaug
- Centre for Health PolicyMelbourne School of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia,Menzies Centre for Health Policy and Economics, Charles Perkins CentreSydney School of Public Health, Faculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia
| | - Natasha Nassar
- The Children's Hospital at Westmead Clinical SchoolFaculty of Medicine and Health, The University of SydneySydneyNew South WalesAustralia
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Billings KR, Bhushan B, Berkowitz RJ, Stake C, Lavin J. Outcomes of a postoperative day one call to families after adenotonsillectomy in children. Laryngoscope Investig Otolaryngol 2022; 7:1200-1205. [PMID: 36000061 PMCID: PMC9392385 DOI: 10.1002/lio2.845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the outcomes of a postoperative day one (POD 1) phone call to families of ambulatory surgical patients, as a means of guiding clinical interventions and quality initiatives, with a focus on children undergoing adenotonsillectomy (T&A). Methods Retrospective analysis of outcomes of a POD 1 questionnaire completed in children <18 years of age undergoing T&A at a tertiary care children's hospital over a 3-year period (August 14, 2018-August 31, 2021). Results Responses to the questionnaire were obtained for a total of 1428/3464 (41.2%) children undergoing T&A during the study period. There was no difference in gender, age at surgery, race, ethnicity, insurance product, or preoperative diagnosis for those whose caregiver responded to the questionnaire versus those who did not. Parent responses included 84 (5.9%) who reported problems or concerns postdischarge. These included 18 (1.3%) patients unable to take their pain medication, 9 (0.6%) refusing oral intake, 28 (2.0%) with postoperative emesis, 27 (1.9%) with fevers, and 6 (0.4%) with a change in breathing. A total of 75/122 (61.5%) who reported pain were taking their pain medication as directed. Nineteen (1.3%) patients were noted to have bleeding after surgery, including 4 (21.5%) with nosebleeds, and 12 (63.2%) with oral cavity bleeding requiring no interventions. Conclusions The POD 1 questionnaire identified patients with common concerns and complications after T&A. Although most of these concerns were infrequent, it afforded the clinical team the opportunity to provide additional education and instructions on care and management to caregivers after their child's surgical procedure.
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Affiliation(s)
- Kathleen R. Billings
- Division of Pediatric Otolaryngology‐Head and Neck SurgeryAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Bharat Bhushan
- Division of Pediatric Otolaryngology‐Head and Neck SurgeryAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Rachel J. Berkowitz
- Data Analytics and ReportingAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Christine Stake
- Department of SurgeryAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Jennifer Lavin
- Division of Pediatric Otolaryngology‐Head and Neck SurgeryAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Krakow AR, Talwar D, Mehta NN, Gandhi JS, Flynn JM. Getting the Message: The Declining Trend in Opioid Prescribing for Minor Orthopaedic Injuries in Children and Adolescents. J Bone Joint Surg Am 2022; 104:1166-1171. [PMID: 35793795 DOI: 10.2106/jbjs.21.01078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Opioids constitute the fastest-growing drug problem among children and adolescents in the United States. Recent heavy media coverage on the opioid prescription epidemic has garnered increased attention from prescribers and policymakers. The purpose of this study was to analyze trends in opioid prescribing for nonoperatively managed pediatric fractures and dislocations in order to examine changes in opioid-prescribing patterns across various U.S. regions. METHODS A retrospective review of the national Pediatric Health Information System (PHIS) database comprising 42 pediatric hospitals was performed to identify pediatric fractures and dislocations presenting to the emergency department (ED) or outpatient clinics from 2004 to 2017. We included patients with the 10 most frequently encountered diagnoses who were nonoperatively managed and were discharged home the same day. To account for hospital variation, we utilized a mixed-effects logistic regression model. RESULTS The final cohort included 134,931 patients, with a mean age (and standard deviation) of 12.57 ± 2.00 years (range, 10 to 18 years); 69.23% of patients were male. Overall, 51.69% of patients were prescribed at least 1 opioid dose during their ED or clinic visits. Of the patients receiving opioids, 72.04% were male and 54.10% were insured through a private insurance plan. When prescription trends were compared according to regions, children were more likely to be prescribed opioids in the South (71.37% more likely) and the Midwest (26.17% more likely) than in the Northeast. CONCLUSIONS Although the opioid prescription rates in all 4 regions have decreased dramatically over the years, some regions were quicker than others in responding to the opioid epidemic. A significant interregional variability in opioid-prescribing practices still exists, but an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis. CLINICAL RELEVANCE Opioid-related misuse is a national epidemic and reducing the use of opioids in pediatric orthopaedic procedures is critical. Although regional variability in opioid-prescribing practices still exists, an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis.
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Affiliation(s)
- Arielle R Krakow
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Divya Talwar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nishank N Mehta
- Department of Orthopaedics, Stony Brook University, Stony Brook, New York
| | | | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Billings KR, Stake C, Arzu J, Lavin J. Outcomes of a Postoperative Data-Extraction Questionnaire After Adenotonsillectomy in Children. Laryngoscope 2021; 131:E2821-E2826. [PMID: 34014559 DOI: 10.1002/lary.29626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate outcomes of a postoperative telephone questionnaire for children who underwent adenotonsillectomy (T&A). To determine whether episodes of postoperative hemorrhage were not captured until the call, and whether this impacted knowledge of physician rates of hemorrhage. STUDY DESIGN Retrospective database analysis. METHODS Retrospective analysis of outcomes of an 11-question data extraction tool utilized at a tertiary care children's hospital for follow-up in T&A patients <18 years of age over a 2-year period. Sub-analysis of positive responses to the question asking about incidence of postoperative hemorrhage. RESULTS During the study period, 1,068/3,142 (34.0%) parents responded to the phone call. Median age was 6.0 years (interquartile range [IQR] 4.0-8.2), and 566 (53.0%) were male. Ninety (8.4%) noted that the child was still snoring, but only 9 (0.84%) reported signs of obstructed breathing. A total of 402 (37.6%) reported a voice change after surgery. Most children (n = 885, 82.9%) did not receive opioid analgesics, and 252 (23.6%) received acetaminophen/ibuprofen 7 days postoperatively. Return visits to the emergency department were reported in 149 patients; primarily for hemorrhage in 46 (30.8%). In 7 (15.2%) patients, the hemorrhage event was not recorded until the call. The majority-of respondents (n = 1,031, 96.5%) were satisfied with the outcome of the procedure. CONCLUSIONS The postoperative T&A tool provided a means of gathering information on success and satisfaction with surgical outcomes. Children were able to be managed primarily with acetaminophen and ibuprofen. Most complications were captured in the electronic record, although some episodes of hemorrhage were not noted until the call, emphasizing the importance of follow-up. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Kathleen R Billings
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Christine Stake
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Jennifer Arzu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jennifer Lavin
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Studer A, Billings K, Thompson D, Ida J, Rastatter J, Patel M, Huetteman P, Hoeman E, Duggan S, Mudahar S, Birmingham P, King M, Lavin J. Standardized Order Set Exhibits Surgeon Adherence to Pain Protocol in Pediatric Adenotonsillectomy. Laryngoscope 2020; 131:E2337-E2343. [PMID: 33314128 DOI: 10.1002/lary.29314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS To produce a sustained reduction in opioid prescriptions in patients <5 years of age undergoing T&A through utilization of standardized algorithms and electronic health record (EHR) automation tools. STUDY DESIGN Prospective quality improvement initiative. METHODS Plan-do-study-act (PDSA) methodology was used to design an age-based postoperative pain regimen in which children <5 years of age received a non-opioid pain regimen, and option to prescribe oxycodone for additional pain relief was given for children >5 years of age. Standardized discharge instructions and automated, age-specific order sets were created to facilitate adherence. Rate of discharge opioid prescription was monitored and balanced against post-discharge opioid prescriptions and returns to the emergency department (ED). RESULTS In children <5 years of age undergoing T&A, reduction in opioid prescription rates from 65.9% to 30.9% after initial implementation of the order set was noted. Ultimately, reduction of opioid prescribing rates to 3.7% of patients was noted after pain-regimen consensus and EHR order set implementation. Opioid prescriptions in patients >5 years of age decreased from 90.6% to 58.1% initially, and then down 35.9% by the last time point analyzed. Requests for outpatient opioid prescriptions did not increase. There was no significant change in returns to the emergency ED for pain management, or in the number opioids prescribed when patients returned to the ED. CONCLUSIONS Iterative cycles of improvement utilizing standardized pain management algorithms and EHR tools were effective means of producing a sustained reduction in opioid prescriptions in postoperative T&A patients. Such findings suggest a framework for similar interventions in other pediatric otolaryngology settings. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2337-E2343, 2021.
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Affiliation(s)
- Abbey Studer
- Center for Quality and Safety, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Kathleen Billings
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Dana Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Jonathan Ida
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Jeff Rastatter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Manisha Patel
- Center for Quality and Safety, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Patricia Huetteman
- Data, Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Erin Hoeman
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Sarah Duggan
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Sukhraj Mudahar
- Department of Pharmacy, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Patrick Birmingham
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.,Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Michael King
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.,Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Jennifer Lavin
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
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Donaldson CD, Jenkins BN, Fortier MA, Phan MT, Tomaszewski DM, Yang S, Kain ZN. Parent responses to pediatric pain: The differential effects of ethnicity on opioid consumption. J Psychosom Res 2020; 138:110251. [PMID: 32979697 PMCID: PMC8552765 DOI: 10.1016/j.jpsychores.2020.110251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/25/2020] [Accepted: 09/13/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Within the context of the United States opioid epidemic, some parents often fear the use of opioids to help manage their children's postoperative pain. As a possible consequence, parents often do not dispense optimal analgesic medications to their children after surgery, putting their children at risk of suffering from postsurgical pain. The objective of this research was to assess ethnicity as a predictor of both pain and opioid consumption, and to examine how Hispanic/Latinx and Non-Hispanic White parents alter their child's opioid consumption in response to significant postsurgical pain. METHODS Participants were 254 children undergoing outpatient tonsillectomy and/or adenoidectomy surgery and their parents. Longitudinal multilevel modeling examined changes in both parent-reported pain and hydrocodone/APAP consumption (mg/kg) on days 1 to 7 after surgery. RESULTS Parent reports of postoperative pain were higher in Hispanic/Latinx patients compared to their Non-Hispanic White counterparts (β = -0.15; 95% CI: -0.28, -0.01). There was also a significant interaction of ethnicity and pain on opioid consumption (β = 0.07; 95% CI: 0.01, 0.13). The relationship between parent perceived pain and opioid use was stronger for Non-Hispanic White children, suggesting that this group was more likely to consume opioids to help manage clinically significant postsurgical pain. CONCLUSIONS Hispanic/Latinx children might be at risk for undertreatment of surgical pain. Findings highlight the importance of assessing parent background and cultural beliefs as predictors of at home pain management and the potential effectiveness of tailored interventions that educate parents about monitoring and treating child postoperative pain.
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Affiliation(s)
- Candice D. Donaldson
- Chapman University, Department of Psychology, United States of America,University of California, Irvine, Center on Stress & Health, United States of America
| | - Brooke N. Jenkins
- Chapman University, Department of Psychology, United States of America,University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Department of Anesthesiology and Perioperative Care, United States of America
| | - Michelle A. Fortier
- University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Sue & Bill Gross School of Nursing, United States of America
| | - Michael T. Phan
- Chapman University, School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, United States of America
| | - Daniel M. Tomaszewski
- Chapman University, School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, United States of America,University of Southern California, School of Pharmacy, Schaeffer Center for Health Policy and Economics, United States of America
| | - Sun Yang
- Chapman University, School of Pharmacy, Department of Pharmacy Practice, United States of America
| | - Zeev N. Kain
- University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Department of Anesthesiology and Perioperative Care, United States of America,Corresponding author at: UCI Center on Stress & Health, 505 S. Main Street, Suite 940, Orange, CA 92868, United States of America. (Z.N. Kain)
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