By Lynda Williams, medwireNews Reporter
medwireNews: Many children and adolescents are receiving opioid prescriptions for prolonged periods after inpatient or outpatient surgical procedures, which is outside the guidelines for their use, suggests research published in JAMA Network Open.
“[P]rofessional societies and available guidance recommend nonsteroidal anti-inflammatory drugs (NSAIDs) with acetaminophen as first-line therapy for procedures that are associated with mild to moderate postoperative pain, including endoscopy and dental [surgical] procedures”, say Tori Sutherland (University of Pennsylvania, Philadelphia, USA) and co-authors.
To determine pre- and postoperative opioid dispensing practices in the USA between 2015 and 2020, the team assessed national claims data on 100,026 youths who were opioid-naïve and scheduled to undergo one of 22 different surgical procedures during this time frame. These included bariatric surgery, colectomy and endoscopy, knee arthroscopy, tonsillectomy, rhinoplasty, craniotomy, circumcision and appendectomy.
The participants were a median of 16.0 years old, half (49.6%) were female, and 7.1% were African American or Black, 2.9% were Asian and 11.1% were Hispanic or Latino. The majority (91.5%) underwent outpatient procedures.
The proportion of patients who filled an initial opioid prescription was 46.9%, at a mean quantity of 227 morphine mg equivalents (MME). Of these prescriptions, 16.2% were filled up to 2 weeks before the procedure.
In addition, 13.8% of the patients filled a second prescription in the 30 days after surgery, for a mean 239 MME, and 3.0% of the patients filled a prescription for a mean 155 MME between 91 and 180 days after surgery, a period of time that the researchers describe as being a “proxy for new persistent opioid use”.
Analysis revealed that the proportion of filled prescriptions and the quantity of opioids filled declined from 2017 onwards but that youths were still being given a similar number of preoperative opioid prescriptions in 2020 as in 2015. However, patients were less likely to fill prescriptions 30 days after surgery over time (15.5% to 11.2%) and the mean MME prescribed fell (264 to 199), as did use of prescriptions 91 to 180 days after surgery (3.5% to 2.1%) and the mean MME at this time (184 to 110).
Preoperative prescriptions were more common in youths aged 18–20 years than younger patients and the researchers highlight that they were “filled for procedures unlikely to be associated with severe preoperative pain, including breast surgery, dental procedures, and rhinoplasty.”
In multivariate analysis, patients were more likely to fill a second prescription up to 30 days after surgery if their initial one was filled 8–14 days before surgery versus after surgery and if they were aged 20 years versus 11 years, with adjusted odds ratios of 5.98 and 2.72, respectively.
The team notes that patients who underwent procedures associated with severe pain or who had a condition with an indication for preoperative opioid use were not at increased risk of developing new persistent opioid use.
Nevertheless, Sutherland and co-workers emphasize that use of opioid prescriptions in the patients “often contradicted professional recommendations” and that “high-risk prescribing practices remained common at the end of the study period.”
They therefore recommend: “These findings should prompt policymakers and perioperative prescribers to use available opioid prescribing guidelines as the standard of care for youths who may require an opioid prescription for pain management.”
News stories are provided by medwireNews, which is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group
JAMA Networ Open 2024; doi:10.1001/jamanetworkopen.2024.20370