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
. 2023 Aug;133(8):1987-1992.
doi: 10.1002/lary.30379. Epub 2022 Sep 2.

Opioid Prescribing Trends After Major Pediatric Ear Surgery: A 12-Year Analysis

Holly Cordray  1   2 , John Galvin  3 , Addison Clark  4 , Kristan Alfonso  1   2 , Kara K Prickett  1   2   5
Affiliations

Opioid Prescribing Trends After Major Pediatric Ear Surgery: A 12-Year Analysis

Holly Cordray et al. Laryngoscope. 2023 Aug.

Abstract

Objective: Postoperative opioid prescriptions tend to exceed children's analgesic needs, but awareness of the opioid epidemic may have driven changes in prescribing behaviors. This study evaluated opioid prescribing patterns after major pediatric ear surgery.

Methods: This study reviewed all cases of tympanoplasty, tympanomastoidectomy, mastoidectomy, cochlear implantation, otoplasty, and aural atresia repair at a pediatric hospital during 2010-2021. Regressions were conducted to identify opioid prescribing trends over time. Potential covariates were assessed. Returns to the system were reviewed as a balancing measure.

Results: Even without a targeted protocol, opioid prescribing declined significantly. After prescribing peaked in 2012-2013, significant negative trends yielded lower rates of opioid prescriptions, fewer doses per prescription, smaller patient-weight-standardized dose sizes, and less variability (all p < 0.001). In 2012, 96.1% of patients received opioid prescriptions; the rate fell to 13.5% by 2021. For patients ages, 0-6, the annual rate of opioid prescriptions dropped from a maximum of 96.3% in 2012 to 0.0% in 2021. The annual average supply of doses per prescription decreased by 68% between 2013 and 2021, reducing the total days' supply to an evidence-based 3.1 ± 1.6 days. Regressions did not detect changes in returns to the system. Pain-related returns were rare (0.9%) and did not vary by opioid prescriptions (p = 0.37). Prescribing trends were closely correlated with a tonsillectomy-focused protocol that our institution implemented in 2019.

Conclusion: Surgeon-driven opioid stewardship has improved with no resultant change in revisit rates. Procedure-specific quality improvement interventions may have broader off-target effects on prescribing behaviors.

Level of evidence: IV Laryngoscope, 133:1987-1992, 2023.

Keywords: opioid analgesics; otolaryngology; otology; pain management; pediatrics; postoperative pain.

PubMed Disclaimer

References

BIBLIOGRAPHY

    1. Anne S, Mims JW, Tunkel DE, et al. Clinical practice guideline: opioid prescribing for analgesia after common otolaryngology operations. Otolaryngol Head Neck Surg. 2021;164(2_suppl):S1-S42.
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292-298.
    1. Kirschner N, Ginsburg J, Sulmasy LS. Prescription drug abuse: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2014;160(3):198-200.
    1. Benchetrit L, Kwock M, Ronner EA, et al. Assessment of pain and analgesic use in children following otologic surgery. Otolaryngol Head Neck Surg. 2021;165(1):206-214.
    1. Boyd C, Shew M, Penn J, et al. Postoperative opioid use and pain management following otologic and neurotologic surgery. Ann Otol Rhinol Laryngol. 2020;129(2):175-180.

Substances

LinkOut - more resources