Bethany J Slater1, Chase G Corvin2, Kurt Heiss3, Robert Vandewalle3, Sohail R Shah4, Megan Cunningham4, EuniceY Huang5, Aaron M Lipskar6, Naomi-Liza Denning6, Melvin Dassinger7, Robert A Cina8, David H Rothstein9, Jeremy Kauffman10, Raquel Gonzalez10, Martha-Conley Ingram11, Mehul V Raval11. 1. Comer Children's Hospital, Pediatric Surgery, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA. Electronic address: bslater@surgery.bsd.uchicago.edu. 2. Comer Children's Hospital, Pediatric Surgery, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA. 3. Pediatric Surgery, Emory University School Of Medicine, Atlanta, GA, USA. 4. Baylor College Of Medicine, Texas Children's Hospital, Pediatric Surgery, Houston, TX, USA. 5. Vanderbilt University Medical Center, Pediatric Surgery, Nashville, TN, USA. 6. Cohen Children's Medical Center, Pediatric Surgery, New Hyde Park, NY, USA. 7. Pediatric Surgery, University Of Arkansas, Little Rock, AR, USA. 8. Pediatric Surgery, The Medical University Of South Carolina, Charleston, SC, USA. 9. Pediatric Surgery, University of Washington, Seattle, WA, USA. 10. John's Hopkins All Children's Hospital, Pediatric Surgery, St. Petersburg, FL, USA. 11. Lurie Children's Hospital of Chicago, Pediatric Surgery, Northwestern University, Chicago, IL, USA.
Abstract
BACKGROUND: The majority of opioid overdose admissions in pediatric patients are associated with prescription opioids. Post-operative prescriptions are an addressable source of opioids in the household. This study aims to assess for sustained reduction in opioid prescribing after implementation of provider-based education at nine centers. METHODS: Opioid prescribing information was collected for pediatric patients undergoing umbilical hernia repair at nine centers between December 2018 and January 2019, one year after the start of an education intervention. This was compared to prescribing patterns in the immediate pre- and post-intervention periods at each of the nine centers. RESULTS: In the current study period, 29/127 (22.8%) patients received opioid prescriptions (median 8 doses) following surgery. There were no medication refills, emergency department returns or readmissions related to the procedure. There was sustained reduction in opioid prescribing compared to pre-intervention (22.8% vs 75.8% of patients, p<0.001, Fig. (1). Five centers showed statistically significant improvement and the other four demonstrated decreased prescribing, though not statistically significant. CONCLUSIONS: Our multicenter study demonstrates sustained reduction in opioid prescribing after pediatric umbilical hernia repair after a provider-based educational intervention. Similar low-fidelity provider education interventions may be beneficial to improve opioid stewardship for a wider variety of pediatric surgical procedures. LEVELS OF EVIDENCE: (treatment study)-level 3.
BACKGROUND: The majority of opioid overdose admissions in pediatric patients are associated with prescription opioids. Post-operative prescriptions are an addressable source of opioids in the household. This study aims to assess for sustained reduction in opioid prescribing after implementation of provider-based education at nine centers. METHODS: Opioid prescribing information was collected for pediatric patients undergoing umbilical hernia repair at nine centers between December 2018 and January 2019, one year after the start of an education intervention. This was compared to prescribing patterns in the immediate pre- and post-intervention periods at each of the nine centers. RESULTS: In the current study period, 29/127 (22.8%) patients received opioid prescriptions (median 8 doses) following surgery. There were no medication refills, emergency department returns or readmissions related to the procedure. There was sustained reduction in opioid prescribing compared to pre-intervention (22.8% vs 75.8% of patients, p<0.001, Fig. (1). Five centers showed statistically significant improvement and the other four demonstrated decreased prescribing, though not statistically significant. CONCLUSIONS: Our multicenter study demonstrates sustained reduction in opioid prescribing after pediatric umbilical hernia repair after a provider-based educational intervention. Similar low-fidelity provider education interventions may be beneficial to improve opioid stewardship for a wider variety of pediatric surgical procedures. LEVELS OF EVIDENCE: (treatment study)-level 3.
Authors: Sean Esteban McCabe; Philip Veliz; Timothy E Wilens; Brady T West; Ty S Schepis; Jason A Ford; Corey Pomykacz; Carol J Boyd Journal: J Am Acad Child Adolesc Psychiatry Date: 2019-03-27 Impact factor: 8.829
Authors: Kaitlin N Piper; Katherine J Baxter; Martha Wetzel; Courtney McCracken; Curtis Travers; Bethany Slater; Sarah B Cairo; David H Rothstein; Robert Cina; Melvin Dassinger; Patrick Bonasso; Aaron Lipskar; Naomi-Liza Denning; Eunice Huang; Sohail R Shah; Megan E Cunningham; Raquel Gonzalez; Jeremy D Kauffman; Kurt F Heiss; Mehul V Raval Journal: J Pediatr Surg Date: 2019-05-11 Impact factor: 2.545
Authors: Calista M Harbaugh; Jay S Lee; Hsou Mei Hu; Sean Esteban McCabe; Terri Voepel-Lewis; Michael J Englesbe; Chad M Brummett; Jennifer F Waljee Journal: Pediatrics Date: 2017-12-04 Impact factor: 7.124
Authors: Ahmed I Eid; Christopher DePesa; Ask T Nordestgaard; Napaporn Kongkaewpaisan; Jae Moo Lee; Manasnun Kongwibulwut; Kelsey Han; April Mendoza; Martin Rosenthal; Noelle Saillant; Jarone Lee; Peter Fagenholz; David King; George Velmahos; Haytham M A Kaafarani Journal: Surgery Date: 2018-07-23 Impact factor: 3.982
Authors: Michael J Nooromid; Eddie Blay; Jane L Holl; Karl Y Bilimoria; Julie K Johnson; Mark K Eskandari; Jonah J Stulberg Journal: Pain Rep Date: 2018-02-06