O3337: Opioid Prescriptions Practices at Discharge Across Common Pediatric Urologic Procedures

Background: Opioid stewardship for pediatric and adolescent patients is essential to reduce risks of opioids. In 2020, the American Pediatric Surgical Association released evidence-based guidelines for opioid prescribing after common urologic surgeries. Procedures were grouped into recommended opioid-free recovery (OFR) and opioid-free recovery possible (OFRP). The purpose of this study is to evaluate the proportion of opioids prescribed at discharge across common procedures in pediatric urologic surgery (URO).

Methods: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2023) was queried for patients < 18 years undergoing elective procedures in URO. Procedures recommended as OFR included circumcision, hypospadias repair, and meatotomy. Procedures considered OFRP included orchiopexy and pyeloplasty. Exclusion criteria included history of cancer, neuromuscular disorders, and patients undergoing multiple procedures by different specialties under the same anesthesia. Descriptive statistics on patient demographics and clinical outcomes were produced. Mann Whitney-U tests were used to compare continuous variables, and categorical variables were compared using a chi-square or Fisher’s exact tests where appropriate.

Results: Among 7,485 patients in the analysis, 4,677 underwent OFR procedures and 2,808 underwent OFRP procedures. Within the OFR cohort, 25.4% of cases were prescribed opioids. There were significant differences in patient characteristics between those prescribed opioids and not, including age (p < 0.0001), history of structural pulmonary/airway abnormality (p < 0.0001), esophageal/gastrointestinal disorder (p < 0.0001), previous cardiac surgery (p=0.003), and preoperative ventilator use (p=0.004) (Table 1). Patients discharged with opioids had significantly longer operative time (p < 0.0001). There were differences in postoperative length of stay (PLOS) (p < 0.0001) and surgical site infections (SSI) within 30 days (p=0.027), but no difference in 30-day unplanned readmissions (Table 1).
Within the OFRP cohort, 22.2% of patients were given at least one prescription. Patients were found to have significant differences regarding age (p < 0.0001), gender (p < 0.011), race (p=0.002), Hispanic ethnicity (p=0.002), history of asthma (p=0.020), and operative time (p < 0.0001). The most common opioids prescribed were oxycodone (72.0%), hydrocodone (16.4%), and oral morphine (10.9%). The PLOS significantly differed (median 1 day, IQR:0-1 vs. 1 day, 0-1, p< 0.0001), but 30-day outcomes of SSI and unplanned readmission did not.

Conclusion: Across URO procedures recommended to be OFR and OFRP, >20% of patients are receiving opioid prescriptions at discharge. Demographic and clinical characteristics may impact who is prescribed opioids. Further research and quality improvement efforts on post-operative pain management protocols and interventions to improve opioid stewardship in pediatric urology are warranted.