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Authors: Harbaugh CM et al.
Pediatrics 2017 Dec 4.
Persistent postsurgical opioid use in adolescents was 5%, similar to the estimated rate in adults.
Prescription opioids, though an important tool for pain management, are contributing to significant morbidity and mortality from opioid overuse and misuse in the U.S. Opioid prescribing practices vary widely, and opioids are often prescribed even after minor procedures.
Using commercial claims data, researchers retrospectively examined risk for persistent prescription opioid use after surgery among approximately 145,000 opioid-naive patients aged 13 to 21 years who underwent 1 of 13 selected operations. Over 40% of participants were aged ≥17 years. A small matched control group of nonsurgical patients was used for comparison. The primary outcome, persistent opioid use, was defined as ≥1 opioid prescription refill between 90 and 180 days after the surgical procedure. Tonsillectomy, arthroscopic knee surgery, and appendectomy accounted for 80% of surgeries. Results were as follows:
- Postoperative opioid prescriptions were filled by 61%, among whom persistent opioid use was found in 5% (range, 3%–15% across surgical procedures).
- Only 0.1% of the matched nonsurgical control group showed persistent opioid use.
- Patients undergoing cholecystectomy and colectomy were significantly more likely to have persistent opioid use compared with those undergoing appendectomy (adjusted odds ratios, 1.1 and 2.3, respectively).
- Independent risk factors were older age, female sex, substance use disorder within the past year, chronic pain diagnosis, and preoperative opioid prescription filling.
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COMMENT
Despite methodologic limitations raised by editorialists, the 5% rate of persistent postsurgical opioid use in these adolescents and young adults is consistent with findings in adults. This represents a significant public health risk, which demands that the prescribing of opioids be standardized and tracked for children, adolescents, and adults. This would include limiting the quantity of opioids dispensed and using non-narcotic pain control whenever possible in postsurgical pain management.