Post-Tonsillectomy Outcomes in Children With and Without Narcotics Prescriptions

Abstract

Objective: To examine differences in outcomes after tonsillectomy in children who received outpatient narcotics prescriptions compared to those who did not. Methods: The MarketScan database was analyzed for claims made for 14 days following tonsillectomy/adenotonsillectomy between 2008 and 2012 for privately insured children 1 to 17 years. Post-op bleeding, dehydration, emergency department (ED) visits, readmissions, and mean total costs for the 14 days after tonsillectomy were compared. Results: Of the 294 795 patients included, 60.9% received a narcotic prescription. Acetaminophen/hydrocodone bitartrate was received by 53.2% of the group receiving narcotic drugs, 42.5% received acetaminophen/codeine phosphate, 3.0% received acetaminophen/oxycodone hydrochloride, and 0.5% received oxycodone hydrochloride alone. Children who had been prescribed narcotics had significantly higher percentages of bleeding complications (2.7% vs 2.5%, P < .001), and ED visits (6.8% vs 6.6%, P < .001) within 14 days, but a lower percentage of readmissions (1.0% vs 1.5%, P < .001). No significant difference was observed between groups for dehydration. There were some age-related differences. The mean total health-care costs for 14 days post-op were the same in each group, except for the 4-to 6-year-olds, where the narcotic group had higher costs (US $7060 vs US $5840, P ¼ .006). Conclusion: In this large-scale study, we found small but statistically significant differences in outcomes related to use of narcotics. The only outcome that benefitted the narcotics group was a lower readmission rate.

Reducing Pediatric Posttonsillectomy Opioid Prescribing: A Quality Improvement Initiative

“…However, with less than a 1% difference between groups in each metric, the clinical significance of these findings is negligible. 23 Overall, our study aligns with previous literature and provides further evidence that decreasing opiate prescriptions does not significantly impact outcomes.…”

Standardization and Reduction of Narcotics After Pediatric Tonsillectomy

“…[5][6][7] To this end, a recent database study discovered that patients who received narcotics had a slightly increased risk of complication but a lower overall readmission rate. 15 Pediatric pain management following tonsillectomy is variable from patient to patient and highly dependent on provider preferences. Historically, codeine represented one of the most common medications for posttonsillectomy pain, but this treatment was abandoned following a black box warning by the Food and Drug Administration in 2013.…”

“…While previous studies showed that patient caregivers prefer to have a narcotic script for backup pain control, recent literature has shown that opinions on this topic may be changing 5–7 . To this end, a recent database study discovered that patients who received narcotics had a slightly increased risk of complication but a lower overall readmission rate 15 …”

Evaluation of the Efficacy of Paracetamol in the Control of Pain After Adenotonsillectomy in the Pediatric Population

“…Adenotonsillectomy is mainly performed for the treatment of obstructive sleep-disordered breathing (oSDB) or recurrent tonsillitis. Currently, oSDB represents the most common surgical indication (almost 70% of cases) [ 2 ].…”

“…It was also found that a subgroup of patients cannot metabolize codeine, which reduces its analgesic effect [ 1 ]. Children with oSDB are more sensitive not only to the respiratory side effect of opioids, but also to their analgesic effect, so they need a lower dose of opioids to obtain the same degree of analgesia [ 2 , 12 ]. The additional benefit of opioids for pain relief that was not controlled by acetaminophen and/or ibuprofen is not well documented, so other therapeutic approaches should be used to minimize the need for opioids [ 13 ].…”