Abstract
Background:
Opioids are commonly prescribed after pediatric orthopedic surgeries. In the United States, wide variations in opioid-prescribing practices exist, even for similar procedures within the same institution. Following many of these procedures, patients typically utilize only a fraction of the post-operative opioids prescribed. This raises questions of standardization of prescribing, appropriate disposal, and prevention of opioid diversion or misuse.
Hypothesis:
The goal of this quality improvement initiative is to identify opioid prescription and utilization patterns between and within sites at our institution, with plans for standardization of pain management techniques for common pediatric sports knee surgeries. We hypothesize that there is a wide range of prescribing habits across multiple facilities.
Methods:
A database query was performed to identify all outpatient and 23-hour observation pediatric sports knee surgeries performed across 10 nationwide sites from January 1, 2021, until December 31, 2023. Surgical cases were identified by either CPT or ICD-10-Procedure codes. Knee arthroscopies were categorized according to prior literature. Patient demographics and prescription data were also collected. Opioid prescriptions written 30 days before and including the day of surgery were considered the initial opioid prescription for a given surgery. Opioid prescriptions written up to post-operative day 30 were considered refills.
Results:
A total of 1834 surgeries were performed on 1523 unique patients across 10 sites. There was a statistically significant difference in the number of opioid doses primarily prescribed for each of the analyzed surgery types across the system. There was no statistical correlation between the number of opioid doses initially primarily prescribed and the refill rate.
Conclusion:
Our system showed a statistically significant variation in post-operative opioid prescribing practices for common pediatric knee surgeries within the analyzed period. However, refill rates were uncorrelated with the number of initially opioid doses prescribed, suggesting a need for standardization in analgesic protocols.