Opioid Prescribing Trends After Major Pediatric Ear Surgery: A 12-Year Analysis

Objective Postoperative opioid prescriptions tend to exceed children's analgesic needs, but awareness of the opioid epidemic may have driven changes in prescribing behaviors. This study evaluated opioid prescribing patterns after major pediatric ear surgery. Methods This study reviewed all cases of tympanoplasty, tympanomastoidectomy, mastoidectomy, cochlear implantation, otoplasty, and aural atresia repair at a pediatric hospital during 2010-2021. Regressions were conducted to identify opioid prescribing trends over time. Potential covariates were assessed. Returns to the system were reviewed as a balancing measure. Results Even without a targeted protocol, opioid prescribing declined significantly. After prescribing peaked in 2012-2013, significant negative trends yielded lower rates of opioid prescriptions, fewer doses per prescription, smaller patient-weight-standardized dose sizes, and less variability (all p < 0.001). In 2012, 96.1% of patients received opioid prescriptions; the rate fell to 13.5% by 2021. For patients ages, 0-6, the annual rate of opioid prescriptions dropped from a maximum of 96.3% in 2012 to 0.0% in 2021. The annual average supply of doses per prescription decreased by 68% between 2013 and 2021, reducing the total days' supply to an evidence-based 3.1 +/- 1.6 days. Regressions did not detect changes in returns to the system. Pain-related returns were rare (0.9%) and did not vary by opioid prescriptions (p = 0.37). Prescribing trends were closely correlated with a tonsillectomy-focused protocol that our institution implemented in 2019. Conclusion Surgeon-driven opioid stewardship has improved with no resultant change in revisit rates. Procedure-specific quality improvement interventions may have broader off-target effects on prescribing behaviors. Level of Evidence IV Laryngoscope, 2022

Automated summary

Objectively, there has been a significant decrease in postoperative opioid prescriptions after major pediatric ear surgery. The rates of prescriptions, doses per prescription, patient-weight-standardized dose sizes, and variability have all decreased. This trend was not associated with changes in returns to the system. The implementation of a tonsillectomy-focused protocol may have influenced prescribing behaviors.