Author: Michael Vlessides
Mimicking results in adults, new research has found that opioid-naive children are at increased risk for persistent opioid use after surgery.
According to a team of investigators at Stanford University School of Medicine, in California, while persistent postoperative opioid use was relatively infrequent among patients less than 12 years of age, use among 12- to 18-year-olds approached that found in adults.
“Several studies have examined this phenomenon in adults, but few have really looked at children,” Dr. Anderson continued. “So, we really started looking at this because there’s just a black hole in that data. We hypothesized that we would discover some of the same characteristics that decreased and increased the risk of persistent postoperative opioid use.”
Dr. Anderson and his colleagues analyzed data from a national insurance claims database with claims from Jan. 1, 2003, through Dec. 30, 2017. Participants in the retrospective cohort study were opioid-naive, aged 18 years or less, and underwent one of the 15 most common surgeries, with anesthesia, in four age groups: 0 to less than 2 years, 2 to less than 6 years, 6 to less than 12 years, and 12 to 18 years.
For the control group, the researchers used a random sample of 25% of the patients in each age group who did not undergo anesthesia within a randomly assigned time frame. The study’s primary outcome was the incidence of persistent postoperative opioid use.
“There’s some variability in the literature with respect to what’s considered persistent and what’s considered chronic postoperative opioid use,” Dr. Anderson told Anesthesiology News. “We defined persistent as any opioid prescription filled from three to six months after surgery.” Chronic opioid use was defined as either filling at least 10 opioid prescriptions or a combined 120 days’ supply of opioids, during the 90 to 365 days after surgery.
As Dr. Anderson reported at the 2019 annual meeting of the International Anesthesia Research Society (abstract D164), rates of persistent postoperative opioid use among surgical patients were found to be 0.50% among those less than 2 years old, 0.55% among 2- to 6-year-olds, 0.85% among 6- to 12-year-olds, and 3.68% among 12- to 18-year-olds.
“The results among 12- to 18-year-olds are similar to what’s been seen in the adult population,” Dr. Anderson noted. “The literature consistently reports rates between 4% and 5%, sometimes as high as 8%.”
By comparison, the rates were 0.17%, 0.33%, 0.45% and 2.04%, respectively, in the four age groups of pediatric nonsurgical patients.
“We found it particularly interesting that even among older pediatric patients who didn’t have surgery, there was still a 2% risk of filling an opioid prescription within the specified time period,” Dr. Anderson noted. “It’s a smaller percentage than the same age group that underwent surgery, but it’s also a much larger population.”
When examining risk factors, the investigators found that tonsillectomy/adenoidectomy, myringotomy and patient age were positively associated with persistent opioid use in all pediatric age groups. Conversely, the year of surgery and Asian race were found to be negatively associated in all age groups.
Of note, the analysis also found that the percentage of patients who received perioperative opioid prescriptions increased in a stepwise fashion for each increasing age group for the majority of the individual procedures included.
Although the rates of persistent opioid use revealed by the study may be troubling, Dr. Anderson believes there are ways to address the situation. “First, we’d like to develop models to help us predict which children are at increased risk of becoming persistent opioid users,” he said.
He also discussed the benefits of preoperative communication and goal setting with patients in an effort to curb persistent postoperative opioid use.