American Association for Hand Surgery
Theme: Beyond Innovation

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Eighty-Nine Percent of Opioids Prescribed For Pediatric Outpatient Surgery Go Unused
Katherine Au, MD; De-An Zhang, MD; Selina Poon, MD, MPH
Shriners For Children Medical Center, Pasadena, CA

Introduction
In 2016, the US Department of Health and Human Services reported there were over 17,000 deaths attributed to prescription opioid overdose. As physicians, we want to ensure that our patients have adequate postoperative pain control, however, we are increasingly cognizant of the issue of opioid addiction. The purpose of this study is to evaluate the opioid prescribing habits of pediatric surgeons and assess the amount of opioid use for postoperative surgical pain.
Methods
This is a retrospective study of outpatient procedures between June 2016 and April 2018 in a single institution. Outpatient cases were classified as "Bone" or "Soft Tissue". All patients were given a patient reported outcome measure (PROM) tracking their daily level of pain along with the number of doses of opioid used.
Results
A total of 720 outpatient procedures were performed and 277 PROMs were collected (38.5%). For those 277 patients, 4744 doses of opioid were prescribed and 4232 doses were unused. Of all opioids prescribed, 89.2% went unused.
52% of patients did not use any opioid medications post-operatively. For the subset that used opioids, an average of 3.84 doses were used over an average of 2.41.7 days. 38.1% used only 1 dose and 95% used 13 doses or less.
The prescriber patterns of Bone versus Soft Tissue were significantly different. For Bone cases, there was no difference in the average prescribed dose for patients who used and did not use opioids (p=0.696). For Soft Tissue cases, the amount of opioid prescribed to those who did not end up using opioids was significantly less (12.99.4 vs 19.38.2, p<0.001) than those who did use opioids.
When comparing between surgical services (plastics, plastics hand, and orthopaedics), orthopaedics prescribed significantly more opioids (p<0.001) and thus had more opioids left over (p<0.012).
Conclusion
Our results show 89% of our prescribed doses of opioids went unused in our study population. Contrary to our expectation, there was no difference in the number of doses and the duration of use of opioids for Bone and Soft Tissue surgery in the outpatient setting.
The significantly higher doses of opioid medication prescribed by orthopaedic surgeons suggests more education is necessary to optimize their postoperative prescribing habits. Our results show that 13 doses of opioid medication are sufficient for 95% of our outpatient surgical patients. This can be a helpful guide for us in our opioid prescribing habits for the management of postoperative pain in children.


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