Investigators at the University of Michigan concluded in a new study that 60% of privately insured children undergoing tonsillectomy had one or more prescription drug claims for opioids between seven days before to one day after the procedure.
In this cohort analysis of 15,793 children who underwent tonsillectomy, having one or more perioperative opioid prescription fills was not associated with fewer or more return visits for pain or dehydration or secondary hemorrhage than nonopioid use, but it was associated with increased risk of return visits for constipation, the authors said.
“Our findings suggest that it may be possible to reduce opioid exposure among children who undergo this common surgery without increasing the risk of complications,” said lead author Kao-Ping Chua, MD, PhD, a pediatrician at University of Michigan C.S. Mott Children’s Hospital and the researcher at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor. Dr. Chiu and his colleagues analyzed national data between 2016 and 2017 from a private insurance database. Among the 15,793 children (aged 1 to 18 years) who underwent a tonsillectomy, six in 10 had one or more filled opioid prescriptions.
American Academy of Otolaryngology–Head and Neck Surgery guidelines strongly recommend non-opioids, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Dr. Chua said that there are several possible explanations for why so many children still received opioid prescriptions despite these guidelines. Among the biggest potential reasons is that the potent painkillers have been believed to provide superior pain relief and reduce the risk of return visits for uncontrolled pain leading to dehydration.
In the study, having a filled opioid prescription wasn’t associated with a difference in risk of return visits for pain or dehydration. But it was linked to an increased risk of constipation and, in at least one case, an opioid overdose, the study found.
Dr. Chua believes surgeons may also prescribe opioids after tonsillectomy because they fear that NSAID use increases bleeding risk. But clinical trials have not demonstrated a significant increase in bleeding risk with their use.
Among children with perioperative fills, the median prescription duration was eight days, an amount that could represent 48 doses of opioids. This is far greater than what the average patient needs, the researchers said. Over-prescribing opioids to children isn’t just a health risk to children, Chua says, but also to family and friends who may have access to the leftover opioids that may not be properly disposed. “To minimize the risks of opioids to children and their families, clinicians should rely on non-opioids when possible. When opioids are used, clinicians should aim to prescribe only the amount that patients need,” Dr. Chua said.