Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun;131(6):1386-1391.
doi: 10.1002/lary.29157. Epub 2020 Oct 6.

Pediatric Post-Tonsillectomy Opioid Prescribing Practices

Yusuf M Agamawi  1 , Lauren M Cass  1 , Maggie Mouzourakis  2 , Jaibir S Pannu  2 , Jennifer V Brinkmeier  1
Affiliations

Pediatric Post-Tonsillectomy Opioid Prescribing Practices

Yusuf M Agamawi et al. Laryngoscope. 2021 Jun.

Abstract

Objective: To evaluate the effect of discharge order sets on prescribing patterns of opioids after pediatric tonsillectomy. Secondary outcomes included encounters for postoperative pain, dehydration, and bleeding.

Methods: Retrospective chart review of pre- and post-intervention in pediatric post-tonsillectomy patients, 0-18 years old (n = 1486). Order sets were installed with age-specific analgesic medication defaults and recommendation of concurrent alternating scheduled ibuprofen and acetaminophen. Time-balanced pre- and post-intervention cohorts were established. Opioid outcomes calculated in morphine milligram equivalents per kilogram (MME/kg) per dosage and total prescribed.

Results: Discharge order set intervention resulted in 17% reduction of opioid dose prescribed (0.095 MME/kg [95% CI, 0.092-0.099] vs. 0.079 [95% CI, 0.076-0.083], P < .001). Total number of opioid doses prescribed was reduced after order set implementation (46.4 [95% CI, 43.6-49.1] to 20.3 [95% CI, 19.1-21.5], P < .001). Patients <7 years old prescribed opioids remained rare in pre- and post-intervention groups (1.6% and 1.8%, respectively, P = .86). Admissions and emergency department visits for postoperative dehydration and pain were significantly reduced. Post-intervention group showed an increase in readmissions for post-tonsillectomy hemorrhage (9.2% vs. 5.2%, P = .003) which was isolated to an increase in the older post-intervention group after stratification by age.

Conclusion: Utilization of order sets with standardized analgesic medication regimen of acetaminophen, ibuprofen, and opioid helped effectively reduce opioid amount per dose, total opioid amount dispensed, and variability in the total opioid amount dispensed while maintaining pain control. An increase in post-tonsillectomy hemorrhage was recognized following this implementation which did not persist after the study period despite continuation of intervention.

Level of evidence: 4 Laryngoscope, 131:1386-1391, 2021.

Keywords: Pediatric; electronic medical record (EMR); opioids; order sets; tonsillectomy.

PubMed Disclaimer

References

BIBLIOGRAPHY

    1. Ramos SD, Mukerji S, Pine HS. Tonsillectomy and adenoidectomy. Pediatr Clin North Am 2013;60:793-807.
    1. Bohr C, Shermetaro C. Tonsillectomy and adenoidectomy. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2019. https://www.ncbi.nlm.nih.gov/books/NBK536942/ Accessed July 20, 2019.
    1. Duval M, Wilkes J, Korgenski K, Srivastava R, Meier J. Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children. Int J Pediatr Otorhinolaryngol 2015;79:1640-1646.
    1. Curtis JL, Harvey DB, Willie S, et al. Causes and costs for ED visits after pediatric adenotonsillectomy. Otolaryngol Head Neck Surg 2015;152:691-696.
    1. Merry AF, Gibbs RD, Edwards J, et al. Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial. Br J Anaesth 2010;104:80-88.

Publication types

MeSH terms

LinkOut - more resources