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A Prospective Analysis of Opioid Use Following Outpatient Pediatric Urologic Surgery

Rachael Sherrer 1 , Ann Byrne 1 ,  Fardod  O’Kelly 2 , Ruthie Su 1 , Walid Farhat 1

1.  Department of Urology, University of Wisconsin—Madison, 2. Division of  Paediatric  Urology, Beacon Hospital & University College Dublin, Ireland

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MP34-13: A PROSPECTIVE ANALYSIS OF OPIOID USE FOLLOWING
OUTPATIENT PEDIATRIC UROLOGIC SURGERY
Rachael Sherrerl, Ann Byrnel, Fardod O'Kelly2, Ruthie Sul, Walid Farhatl
1. Department Of Urology, University Of Wisconsin—Madison 2. Division Of Paediatric Urology, Beacon Hospital Dublin & University College Dublin, Ireland
Table 1. Mean doses of opioid used per patient.
Introduction
• Surgical prescribing is a significant contributor to the current opioid crisis
• While opioids have a role in multimodal post-operative analgesia, they may
not be routinely needed after outpatient pediatric surgery
• Post-operative opioid needs for pediatric patients after outpatient urologic
procedures is not well-characterized
• Opioid prescription in this setting varies widely, and over-prescription is
common
Opioids are associated with side effects including drowsiness, nausea, and
constipation, and excess doses may be misused or diverted
• Given this lack of consensus on opioid needs and prescription in this setting,
we examined impact of patient characteristics and surgery type on opioid
usage in our pediatric outpatient urologic surgery cohort
Surgery type
Genital
Inguinal
Laparoscopic
Cystoscopic
Age group (years)
0-3
3-7
7-12
White
Hispanic
Black
Unknown
n (0/0)
138 (75.8)
21 (11.5)
17 (9.34)
6 (3.30)
89 (48.9)
35 (192)
34 (18.7)
24 (13.2)
137 (75.3)
16 (8.79)
12 (6.59)
9 (4.95)
Mean opioid doses (95% cn
0.963 (0.74-1.25)
1.57 (0.898-2.75)
1.21 (0.611-2.38)
1.67 (0.784-3.55)
1.02 (0.769-1.36)
0.914 (0.545-1.53)
0.794 (0.511-124)
1.94 (1.13-3.32)
0.978 (0.752-1.27)
1.19 (0.586-2.41)
1.42 (0.779-2.58)
2.11 (0.997-4.47)
Conclusions
Methods
• Opioid use data was prospectively collected over a
12-month period (January to December 2020) via
routine institutional post-operative telephone calls to
families
• Patient characteristics (age, sex, race), surgery type,
and opioid prescription and refill information were
recorded from the EHR
• Patients who were admitted or had simultaneous
surgery with another specialty were excluded
All patients were prescribed scheduled
acetaminophen and ibuprofen for 48 hours after
surgery, then as needed, when not contraindicated
• Patients were prescribed up to 5 doses of oxycodone
• The count Of opioid doses was modelled using
negative binomial regression with robust standard
errors
Results
• 263 patients met inclusion criteria
• Patients were predominantly male (99%) with mean age 5.1
years and mean 4.9 opioid doses prescribed per patient.
• There were 138 genital, 21 inguinal, 17 laparoscopic, and 6
cystoscopic procedures.
• Mean opioid use was one single dose
• Over half (52%) of patients who were prescribed opioids
used none
• Mean number Of excess, unused prescribed opioid doses
per patient was 4. This totaled 694.5 doses for this cohort.
• 11 patients used all prescribed doses and one received a
refill of 5 additional doses
• As outlined in Table 1, patient age, race, and surgery type
were not independent predictors Of opioid use on
multivariable analysis, although there was a trend toward
increased use in adolescents
• 93% Of patients did not use all Of their opioid
prescription and had excess, unused doses
• 52% of patients used no opioids at all
• While overall opioid use was low across all
sub-cohorts, there was a trend toward
increased use in adolescents
• Our findings suggest that opioids are in fact
likely over-prescribed after outpatient
pediatric urologic surgery
• Further research is needed to better
characterize optimal prescribing patterns in
this setting to minimize harms of opioids
while maintaining effective post-operative
analgesia

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Surgical prescribing is significant contributor to opioid crisis Opioids may not be routinely needed after outpatient surgery Prescription patterns vary widely Opioid needs after peds urology procedures not well-characterized We examined impact of patient characteristics and surgery type on opioid usage after outpatient pediatric urologic surgery

MP34-13: A PROSPECTIVE ANALYSIS OF OPIOID USE FOLLOWING
OUTPATIENT PEDIATRIC UROLOGIC SURGERY
Rachael Sherrerl, Ann Byrnel, Fardod O'Kelly2, Ruthie Sul, Walid Farhatl
1. Departrnent of Urology. University of Wisconsin—Madison 2. Division of Paediatric Urology. Beacon Hospital Dublin & University College Dublin. Ireland

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Included patients undergoing outpatient pediatric urologic surgery Prospective data collection via post-op phone calls over 12 months Patient characteristics, surgery type, opioid prescription info recorded from EHR Prescribed scheduled multimodal analgesia for 48 hours and up to 5 doses oxycodone

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Table 1.
Surgery type
Genital
Inguinal
Mean doses of opioid used per patient.
Laparoscopic
Cystoscopic
Age group (years)
0-3
3-7
7-12
Race
White
Hispanic
Black
Other
Unknown
138 (75.8)
21 (11.5)
17 (9.34)
6 (3.30)
89 (48.9)
35 (19.2)
34 (18.7)
24 (13.2)
137 (75.3)
16 (8.79)
12 (6.59)
9 (4.95)
8 (4.40)
Mean opioid doses
0.963 (0.74-1.25)
1.57 (0.898-2.75)
1.21 (0.611-2.38)
1.67 (0.784-3.55)
1.02 (0.769-1.36)
0.914 (0.545-1.53)
0.794 (0.511-1.24)
1.94 (1.13-3.32)
0.978 (0.752-1.27)
1.19 (0.586-2.41)
1.42 (0.779-2.58)
2.11 (0.997-4.47)

263 patients, 182 received an opioid prescription Mean opioid use was  one  single dose 52% of those prescribed opioids used  none 93% had excess, unused doses Total 694.5 excess doses prescribed Patient age, race, and surgery type were not independent predictors of opioid use Trend toward increased use in adolescents

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Opioids over-prescribed after outpatient pediatric urologic surgery Further research needed to better characterize optimal prescribing patterns to minimize harms of opioids while maintaining adequate post-operative analgesia

MP34-13: A PROSPECTIVE ANALYSIS OF OPIOID USE FOLLOWING
OUTPATIENT PEDIATRIC UROLOGIC SURGERY
Rachael Sherrerl, Ann Byrnel, Fardod O'Kelly2, Ruthie Sul, Walid Farhatl
1. Department of Urology. University of Wisconsin—Madison 2. Division of Paediatric Urology. Beacon Hospital Dublin & University College Dublin. Ireland

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