Changes in Postoperative Opioid Prescribing Five-Year Practice Patterns Identified in Pediatric Urologists
Daniel M. Tennenbaum, MD1, Jeffrey S. Palmer, MD2, Lane S. Palmer, MD2.
1Maimonides Medical Center, Brooklyn, NY, USA, 2Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
BACKGROUND: Over-prescribing of opioids has been identified as one of the primary causes of the opioid crisis, accounting for nearly half of opioid-related overdose deaths. Though proper postoperative analgesia is important, many surgeons tend to overprescribe opioids postoperatively. Further, studies indicate that postoperative patients are at increased risk of opioid dependence compared to medical patients, with ~6% of opioid-naÔve patients demonstrating continued use beyond the postoperative period.
In response, concerted efforts are being made nation-wide to assure proper opioid-prescribing patterns. It has now been established that appropriate postoperative analgesia can be provided with little-to-no opioid prescribing for most pediatric urology patients after outpatient procedures. Despite this, there is significant variability in opioid prescribing after surgery. However, little is known about how practice-patterns have changed amongst pediatric urologists over the last five years, and why patterns may have changed. In this study, we seek to identify what changes in practice patterns have occurred within the pediatric urology community in terms of opioid prescribing for postoperative care upon discharge. METHODS: We surveyed pediatric urologists regarding current prescribing patterns of postoperative opioids for 12 operations and how it compared to 5 years prior. Surgeries were stratified as penile [hypospadias repair (distal and proximal), meatoplasty, penile surgery otherwise not described], groin [orchiopexy (inguinal), inguinal hernia repair, varicocele (open)], laparoscopic [orchiopexy, varicocele], open surgery [ureteral reimplant, pyeloplasty] and ureteroscopy. The survey also assessed respondent characteristics and attitudes regarding opioids. RESULTS: Surveys were sent to 300 individuals, and 54 completed the survey, for a response rate of 18.%. The majority of respondents were male, from all AUA sections. 63% of respondents practiced for more than ten years. Approximately half the respondents were in academic practice, with the remainder divided between private and hybrid practice models. 83% of respondents were involved in resident or fellow education. Among respondents practicing greater than five years, 80% believed their opioid prescribing practice pattern had changed. 94% attributed their change at least partially due to concern with the opioid crisis, while 54% attributed their change at least partially to their observation of successful non-opioid pain control for patientsí other than their own. The remaining 20% of respondents had not changed prescribing pattern most commonly (55%) for "peace of mind of a comfortable patient". Among the 12 surgeries, all procedures showed a downtrend in always or almost always prescribing postoperative opioids and similarly uptrend in never or rarely prescribing postoperative opioids. Graph 1 provides examples of practice pattern changes in postoperative opioid prescribing across four of the 12 surveyed procedures. CONCLUSIONS: The vast majority of pediatric urologists have reduced their opioid prescribing patterns over the past 5 years largely over concern of the current opioid crisis in the US as well as observing alternative analgesic options. Similar shifts in prescribing patterns should have a significant impact on the current opioid crisis.
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