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A Societies for Pediatric Urology survey of opioid prescribing practices after ambulatory pediatric urology procedures.

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.

Authors+Show Affiliations

University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA. Electronic address: jennifer.ahn@seattlechildrens.org.Medical College of Wisconsin, USA; Children's Hospital of Wisconsin, USA.University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31160172

Citation

Ahn, J J., et al. "A Societies for Pediatric Urology Survey of Opioid Prescribing Practices After Ambulatory Pediatric Urology Procedures." Journal of Pediatric Urology, 2019.
Ahn JJ, Ellison JS, Merguerian PA. A Societies for Pediatric Urology survey of opioid prescribing practices after ambulatory pediatric urology procedures. J Pediatr Urol. 2019.
Ahn, J. J., Ellison, J. S., & Merguerian, P. A. (2019). A Societies for Pediatric Urology survey of opioid prescribing practices after ambulatory pediatric urology procedures. Journal of Pediatric Urology, doi:10.1016/j.jpurol.2019.04.025.
Ahn JJ, Ellison JS, Merguerian PA. A Societies for Pediatric Urology Survey of Opioid Prescribing Practices After Ambulatory Pediatric Urology Procedures. J Pediatr Urol. 2019 May 2; PubMed PMID: 31160172.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Societies for Pediatric Urology survey of opioid prescribing practices after ambulatory pediatric urology procedures. AU - Ahn,J J, AU - Ellison,J S, AU - Merguerian,P A, Y1 - 2019/05/02/ PY - 2019/01/01/received PY - 2019/04/25/accepted PY - 2019/6/5/entrez KW - Opioid stewardship KW - Postoperative analgesia KW - Practice patterns JF - Journal of pediatric urology JO - J Pediatr Urol N2 - 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. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/31160172/A_Societies_for_Pediatric_Urology_survey_of_opioid_prescribing_practices_after_ambulatory_pediatric_urology_procedures L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(19)30096-8 DB - PRIME DP - Unbound Medicine ER -