Retrospective study of the effect of opioid prescribing guidelines on prescribing practices in pediatric orthopedic sports medicine patients having knee surgery: A single institution's experience

Jeffrey G. Stepan, MD, MSc; Christine Goodbody, MD; Kanupriya Kumar, MD; Kathryn DelPizzo, MD; Peter Fabricant, MD, MPH; Pamela Wendel, MD

doi:10.5055/jom.2021.0660

Authors

Jeffrey G. Stepan, MD, MSc
Christine Goodbody, MD
Kanupriya Kumar, MD
Kathryn DelPizzo, MD
Peter Fabricant, MD, MPH
Pamela Wendel, MD https://orcid.org/0000-0001-7181-8107

DOI:

https://doi.org/10.5055/jom.2021.0660

Keywords:

analgesics, opioid, retrospective studies, adolescent, oxycodone, prescriptions

Abstract

Objective: Guidelines for opioid prescription post-operatively exist; however, the majority of these are for adults. Nevertheless, opioid risks are present for pediatric patients also. This study investigates the effect of a single institution's guidelines on post-operative opioid prescribing for pediatric orthopedic patients undergoing knee surgery. We hypothesized that a standardized set of prescribing guidelines would result in a decrease in opioids prescribed at discharge home after these surgeries.

Design: Retrospective observational.

Setting: Urban, tertiary care, academic orthopedic hospital.

Patients: Pediatric, sports knee surgery, 23-month period.

Interventions: Guidelines were implemented institutionally for post-operative opioid prescribing practices. We reviewed all post-operative opioid prescriptions for pediatric patients undergoing sports knee surgery with two pediatric sports surgeons for the 11 months prior to the guidelines and 12 months afterwards, totaling 316 surgeries.

Main outcome measure: Oral morphine equivalents (OMEs) prescribed on discharge from the hospital before and after implementation of guidelines.

Results: There was a significant reduction in OMEs from 229 OMEs to 175 OMEs before and after opioid prescribing guidelines (p < 0.001). This is a decrease in approximately seven 5 mg oxycodone tablets per patient.

Conclusions: This study demonstrates that at our institution, with a pediatric patient population having sports knee surgery, prescribing guidelines reduced the number of opioids prescribed at discharge.

Author Biographies

Jeffrey G. Stepan, MD, MSc

Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois

Christine Goodbody, MD

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York

Kanupriya Kumar, MD

Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medical College, New York, New York

Kathryn DelPizzo, MD

Department of Anesthesiology, Critical Care, & Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medical College, New York, New York

Peter Fabricant, MD, MPH

Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Research Division, Hospital for Special Surgery, New York, New York; and Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York

Pamela Wendel, MD

Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medical College, New York, New York

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