The Over-prescription of Postoperative Pain Medication - How Much Do Pediatric Urologists Contribute?
Zachary Rye, MS1, Denise Juhr, MS, Patrick Ten Eyck, PhD, Christopher Cooper, MD, Gina Lockwood, MD, Douglas Storm, MD.
University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
BACKGROUND: Over prescription of pain medications is a public crisis. We sought to better understand pediatric urology patients' postoperative pain, their pain requirements and the prescribing practices of pediatric urology providers.
METHODS: Parents of children undergoing pediatric urologic operations at a single academic medical center were recruited for this study. All patients were prescribed a standard dose of oxycodone, acetaminophen, and ibuprofen. For one week following the operation, a text message was sent to the parents each evening. Within the text message was a linked survey from which parents rated their child's pain using the Faces Pain Scale and recorded the number of doses of each medication administered over the last 24 hours. This prospectively collected data was evaluated using generalized linear modeling.
RESULTS: 120 parents were enrolled with a mean child age of 33.4 months (5-169 months). 97% of the patients were male and 83% had private insurance. Surgical procedures included: circumcision (35%), communicating hydrocele repair (11%), hypospadias repair (22%), orchiopexy (29%) and ureteral reimplantation (3%). The average prescribed amount of each medication was: oxycodone - 13.2 doses, acetaminophen - 48.6 doses, and ibuprofen - 34.3 doses.
Over seven days, the average pain score was 1.62, significantly improving from postoperative day 1 (4.19) to day 7 (0.95) (p < 0.01). The average number of doses of any pain medication utilized by our patients was 18.6 (0-51 doses) and improved from day #1 (7.3) to day #7 (1.2) (p < 0.01). On average, oxycodone was overprescribed by 10 doses and acetaminophen and ibuprofen by 41 doses and 26 doses, respectively. Generalized linear analysis predicted an increased pain medication requirement and higher average pain score in patients undergoing orchiopexy (p=0.01), hydrocele repair (p=0.01), hypospadias surgery (p<0.01) and ureteral reimplantation (p=0.01). Patient age did not affect the average pain score or medication requirement (p=0.09).
CONCLUSIONS: Currently all post-operative pain medications, including opioids, are over prescribed and we have a poor understanding of our patients' post-operative pain requirements. To this end, work to create a model that predicts postoperative pain medication requirements based on the procedure type and age is underway.
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