Which Surgeries Drive the Most Opioid Prescriptions in Youth

TOPLINE:

A small pool of major surgeries accounts for a large portion of opioids prescribed to children and teens, according to a new study published in Pediatrics.

METHODOLOGY:

• The researchers analyzed national commercial and Medicaid claims from December 2020 to November 2021 in children aged 0-21 years.
• More than 200,000 procedures were included in the study.
• For each type of surgery, researchers calculated the total amount of opioids given within 3 days of discharge, measured in morphine milligram equivalents (MMEs).

TAKEAWAY:

• In children up to age 11 years, three procedures accounted for 59.1% of MMEs: Tonsillectomy and/or adenoidectomy (50.3%), open treatment of upper extremity fracture (5.3%), and removal of deep implants (3.5%).
• In patients aged 12-21 years, three procedures accounted for 33.1% of MMEs: Tonsillectomy and/or adenoidectomy (12.7%), knee arthroscopy (12.6%), and analgesia after cesarean delivery (7.8%).
• Refill rates for children were all 1% or less.
• Refill rates for adolescents ranged from 2.3% to 9.6%.

IN PRACTICE:

“Targeting these procedures in opioid stewardship initiatives could help minimize the risks of opioid prescribing while maintaining effective postoperative pain control,” the researchers wrote.

SOURCE:

The study was led by Kao-Ping Chua, MD, PhD, of the Department of Pediatrics at the University of Michigan Medical School, in Ann Arbor, Michigan, and published on June 26, 2024, in Pediatrics.

LIMITATIONS:

The researchers analyzed opioids prescribed only after major surgeries. The sources of data used in the analysis may not fully represent all pediatric patients.

DISCLOSURES:

Chua reported consulting fees from the US Department of Justice and The Benter Foundation outside the submitted work. Other authors reported a variety of financial interests, including consulting for the pharmaceutical industry.