Societies for Pediatric Urology

SPU Home SPU Home Past & Future Meetings Past & Future Meetings

Back to 2024 Abstracts


Less Is More: Factors Associated With Decreased Opioid Use In Pediatric Urologic Surgery
Nicolette G. Payne, MD1, Daniel Salevitz, MD1, Grace Madura, MS2, Chung-Yon Lin, MD1, Kelly Parker, PA-C3, Gwen M. Grimsby, MD3.
1Mayo Clinic AZ, Phoenix, AZ, USA, 2Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA, 3Phoenix Children’s, Phoenix, AZ, USA.


Background: Efforts to mitigate the detriments of the opioid epidemic in the United States is a crucial issue. For post-operative pain management, surgeons must balance the risk of potential opioid misuse with providing adequate pain control. However, there are no clear urologic post-operative opioid prescription guidelines in the pediatric population. At our institution, we implemented opioid prescription reduction education to pediatric urology staff in 2018. A prior review of our data found that in 2017, 63% of patients were prescribed opioids after surgery, compared with only 6% of patients in 2023 (p<0.0001), Figure 1. The objective of this study was to is to examine current opioid prescribing practices at our institution and to assess if a reduction in opioid prescribing after pediatric urologic surgery increased post-operative nursing calls or emergency department (ED) visits.
Methods: From 2017 to 2023, a written questionnaire was administered to all patients at their post-operative visits regarding what pain medications were used at home after urologic surgery. A retrospective chart review was performed of all patients who completed pain questions from 2017 to 2023. Clinical and demographic factors including ED visits and nurse calls were compared between patients who did and did not use opioids with Fisher’s exact and t-tests.
Results: A total of 1630 patients were included with a mean age of 5.3 years old, 95% of which were male. From 2017 to 2023, 550 patients (34%) were prescribed opioids and of these, 474/550 (86%) used opioids after surgery and 450/558 (82%) had leftover opioids. Only 6% of patients not prescribed opioids felt that they should have been. Older patients were significantly more likely to use opioids and (p<0.0001) and endoscopic surgery type was significantly associated with less frequent use of opioids (p=0.0032), Table 1. Use of ibuprofen or and alternating ibuprofen and acetaminophen was associated with decreased opioid use (p<0.0001), Table 1. Compared with patients who did not use opioids, those who used opioids after surgery were significantly more likely to call the clinic nurses (6% vs 2%, p=0.0011) and/or visit the ED (3% vs 0.7%, p = 0.0020) for pain after surgery.
Conclusions: Minimal post-operative opioids are needed after pediatric urologic procedures. Despite significantly reducing the opioid prescription rate from 63% to 5% over 6 years, ED visits and nurse calls for pain did not significantly increase. Patients who were prescribed opioids actually had higher rates of presenting to the ED after surgery or calling the clinic nurses for pain. Utilization of NSAIDs was associated with decreased opioid use, which emphasizes the importance of counseling patients on the use of multimodal nonnarcotic pain medication after surgery. Further guidelines from specialty society are needed to guide opioid prescription practices after pediatric urologic surgery.

Table 1 - Comparison of patients who used versus did not use opioids after urologic surgery
Did not use opioids n=1,162Used opioids n=470P value
Age (yrs) mean (SD)4.1 (5.0)4.7 (5.5)<0.0001
Male, n (%)1104 (95)451 (96)0.4934
Surgery type, n (%)
- penile surgery616 (53)254 (54)0.7308
- scrotal/inguinal330 (28)148 (31)0.2930
- open abdominal46 (4)25 (5)0.2254
- endoscopy61 (5)10 (2)0.0050
- laparoscopic/robotic surgery22 (2)8 (2)0.7915
- combo84 (7)27 (6)0.2775
- labial2 (0.1)0 (0)0.3680
Prescribed opioids, n (%)87 (7)470 (100)--
- prescribed by surgeon after surgery82 (7)470 (100)--
- prescribed by nurses after family called in for pain5 (0.4)6 (1)*--
Prescribed opioids but did not use them n (%)80 (7)NA--
Not prescribed opioids but felt they should have been n (%)68 (6)NA--
Opioid doses used, mean (SD)NA4.9 (5.6)--
Had leftover opioids, n (%)77 (7)373 (79)--
Called nurses about pain; n (%)27 (2)27 (6)0.0005
Went to ED for pain; n (%)8 (0.7)12 (3)0.0020
ED prescribed opioids; n (%)0 (0)2 (0.4)0.2038
Used only ibuprofen; n (%)86 (7)127 (27)<0.0001
Used only acetaminophen; n (%)235 (20)61 (13)0.5900
Alternated ibuprofen and acetaminophen; n (%)751 (65)132 (28)<0.0001


Back to 2024 Abstracts