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 journalArticlepeer-review

24 Scopus citations


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
Issue number6
StatePublished - Jun 2019


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

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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