Opioid Prescribing Trends After Major Pediatric Ear Surgery: A 12‐Year Analysis

Abstract

Objective Postoperative opioid prescriptions tend to exceed children's analgesic needs, but awareness of the opioid epidemic may have driven changes in prescribing behaviors. This study evaluated opioid prescribing patterns after major pediatric ear surgery. Methods This study reviewed all cases of tympanoplasty, tympanomastoidectomy, mastoidectomy, cochlear implantation, otoplasty, and aural atresia repair at a pediatric hospital during 2010–2021. Regressions were conducted to identify opioid prescribing trends over time. Potential covariates were assessed. Returns to the system were reviewed as a balancing measure. Results Even without a targeted protocol, opioid prescribing declined significantly. After prescribing peaked in 2012–2013, significant negative trends yielded lower rates of opioid prescriptions, fewer doses per prescription, smaller patient‐weight‐standardized dose sizes, and less variability (all p < 0.001). In 2012, 96.1% of patients received opioid prescriptions; the rate fell to 13.5% by 2021. For patients ages, 0–6, the annual rate of opioid prescriptions dropped from a maximum of 96.3% in 2012 to 0.0% in 2021. The annual average supply of doses per prescription decreased by 68% between 2013 and 2021, reducing the total days' supply to an evidence‐based 3.1 ± 1.6 days. Regressions did not detect changes in returns to the system. Pain‐related returns were rare (0.9%) and did not vary by opioid prescriptions (p = 0.37). Prescribing trends were closely correlated with a tonsillectomy‐focused protocol that our institution implemented in 2019. Conclusion Surgeon‐driven opioid stewardship has improved with no resultant change in revisit rates. Procedure‐specific quality improvement interventions may have broader off‐target effects on prescribing behaviors. Level of Evidence IV Laryngoscope, 133:1987–1992, 2023

Opioid prescription rates associated with surgery among adolescents in the United States from 2015 to 2020

“…While it is clear that nonsurgical opioid prescription rates has decreased over time, opioid prescribing associated with surgery remains less well described. Recent publications found decreasing rates of opioid prescribing associated with specific pediatric surgeries at single academic institutions, including following major ear surgery and anterior cruciate ligament repair over the past decade 20,21 . However, a study by Donohue et al, found stable rates of opioid prescribing for pediatric outpatient surgery at a multispecialty children's hospital and freestanding surgery center 22 .…”

“…Hudgins et al found a small, but significant decrease in opioid prescribing for adolescent emergency department visits between 2005 and 2015 using data from the National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey 13. Using Optum Clinformatics Data Mart, a large commercial insurance provider dataset, Gagne et al showed that the mean monthly prevalence of outpatient opioid prescriptions per 1000 children or adolescents peaked at 5.8 in 2008 and steadily declined to 2.7 by 2017(20). However, this study was limited by only including private or commercial insurance holders which excludes a large subset of the pediatric population known to experience opioid management disparities-namely, uninsured patients and those paying out-of-pocket.…”