Decreased opioid prescribing in children using an enhanced recovery protocol

Katherine J. Baxter, Heather L. Short, Martha Wetzel, Rebecca S. Steinberg, Kurt F. Heiss, Mehul V Raval*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: A previously implemented Enhanced Recovery Protocol (ERP)for children undergoing elective gastrointestinal operations demonstrated decreased length of stay (LOS)and in-hospital opioid use. We hypothesized that the ERP would be associated with decreased postdischarge opioid prescribing. Methods: Demographic, operative, and opioid prescription data were retrospectively compared between elective gastrointestinal surgical patients in the pre-ERP (1/2012–12/2014)and the post-ERP periods (1/2015–12/2017). Results: Of the 99 patients reviewed, 56 (56.7%)were treated in the post-ERP era. Overall, 48 (48.5%)were male, and the most common operation was partial or total colectomy (n = 39, 39.4%)followed by ileocecectomy (n = 26, 26.3%). Most patients were 15–16 years of age and had inflammatory bowel disease (n = 88, 88.9%). LOS decreased from a median 4 days pre-ERP to 3 days post-ERP (p = 0.02). Patients receiving intraoperative opioids decreased from 100% to 46% (p < 0.01)and postoperative opioids from 95% to 59% (p < 0.01). Patients receiving an opioid prescription at discharge decreased from 69.8% pre-ERP to 30.9% post-ERP (p < 0.01). Among patients prescribed opioids at discharge, the number of doses (median 23 to 17, p = 0.44)and the median morphine equivalents/kg remained stable (median 2.3 to 1.7, p = 0.10). Conclusions: A pediatric gastrointestinal surgery ERP resulted in decreased postdischarge prescribing of opioids. Type of study: Retrospective cohort study. Level of Evidence: Level II.

Original languageEnglish (US)
Pages (from-to)1104-1107
Number of pages4
JournalJournal of pediatric surgery
Volume54
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Opioid Analgesics
Prescriptions
Length of Stay
Colectomy
Inflammatory Bowel Diseases
Morphine
Cohort Studies
Retrospective Studies
Demography
Pediatrics

Keywords

  • Enhanced recovery
  • Narcotics
  • Opioids
  • Pediatric surgery
  • Stewardship

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Baxter, Katherine J. ; Short, Heather L. ; Wetzel, Martha ; Steinberg, Rebecca S. ; Heiss, Kurt F. ; Raval, Mehul V. / Decreased opioid prescribing in children using an enhanced recovery protocol. In: Journal of pediatric surgery. 2019 ; Vol. 54, No. 6. pp. 1104-1107.
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title = "Decreased opioid prescribing in children using an enhanced recovery protocol",
abstract = "Background: A previously implemented Enhanced Recovery Protocol (ERP)for children undergoing elective gastrointestinal operations demonstrated decreased length of stay (LOS)and in-hospital opioid use. We hypothesized that the ERP would be associated with decreased postdischarge opioid prescribing. Methods: Demographic, operative, and opioid prescription data were retrospectively compared between elective gastrointestinal surgical patients in the pre-ERP (1/2012–12/2014)and the post-ERP periods (1/2015–12/2017). Results: Of the 99 patients reviewed, 56 (56.7{\%})were treated in the post-ERP era. Overall, 48 (48.5{\%})were male, and the most common operation was partial or total colectomy (n = 39, 39.4{\%})followed by ileocecectomy (n = 26, 26.3{\%}). Most patients were 15–16 years of age and had inflammatory bowel disease (n = 88, 88.9{\%}). LOS decreased from a median 4 days pre-ERP to 3 days post-ERP (p = 0.02). Patients receiving intraoperative opioids decreased from 100{\%} to 46{\%} (p < 0.01)and postoperative opioids from 95{\%} to 59{\%} (p < 0.01). Patients receiving an opioid prescription at discharge decreased from 69.8{\%} pre-ERP to 30.9{\%} post-ERP (p < 0.01). Among patients prescribed opioids at discharge, the number of doses (median 23 to 17, p = 0.44)and the median morphine equivalents/kg remained stable (median 2.3 to 1.7, p = 0.10). Conclusions: A pediatric gastrointestinal surgery ERP resulted in decreased postdischarge prescribing of opioids. Type of study: Retrospective cohort study. Level of Evidence: Level II.",
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Decreased opioid prescribing in children using an enhanced recovery protocol. / Baxter, Katherine J.; Short, Heather L.; Wetzel, Martha; Steinberg, Rebecca S.; Heiss, Kurt F.; Raval, Mehul V.

In: Journal of pediatric surgery, Vol. 54, No. 6, 01.06.2019, p. 1104-1107.

Research output: Contribution to journalArticle

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T1 - Decreased opioid prescribing in children using an enhanced recovery protocol

AU - Baxter, Katherine J.

AU - Short, Heather L.

AU - Wetzel, Martha

AU - Steinberg, Rebecca S.

AU - Heiss, Kurt F.

AU - Raval, Mehul V

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AB - Background: A previously implemented Enhanced Recovery Protocol (ERP)for children undergoing elective gastrointestinal operations demonstrated decreased length of stay (LOS)and in-hospital opioid use. We hypothesized that the ERP would be associated with decreased postdischarge opioid prescribing. Methods: Demographic, operative, and opioid prescription data were retrospectively compared between elective gastrointestinal surgical patients in the pre-ERP (1/2012–12/2014)and the post-ERP periods (1/2015–12/2017). Results: Of the 99 patients reviewed, 56 (56.7%)were treated in the post-ERP era. Overall, 48 (48.5%)were male, and the most common operation was partial or total colectomy (n = 39, 39.4%)followed by ileocecectomy (n = 26, 26.3%). Most patients were 15–16 years of age and had inflammatory bowel disease (n = 88, 88.9%). LOS decreased from a median 4 days pre-ERP to 3 days post-ERP (p = 0.02). Patients receiving intraoperative opioids decreased from 100% to 46% (p < 0.01)and postoperative opioids from 95% to 59% (p < 0.01). Patients receiving an opioid prescription at discharge decreased from 69.8% pre-ERP to 30.9% post-ERP (p < 0.01). Among patients prescribed opioids at discharge, the number of doses (median 23 to 17, p = 0.44)and the median morphine equivalents/kg remained stable (median 2.3 to 1.7, p = 0.10). Conclusions: A pediatric gastrointestinal surgery ERP resulted in decreased postdischarge prescribing of opioids. Type of study: Retrospective cohort study. Level of Evidence: Level II.

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KW - Pediatric surgery

KW - Stewardship

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