Pediatric Consent Forms Decrease Overall Opioid Prescriptions

by Amy E. Hamaker •

Do the amount of opioids prescribed and postoperative outcomes after adenotonsillectomy change following implementation of mandated opioid consent forms?

Bottom Line: A mandated consent form prior to opioid prescription was associated with decreased overall opioid prescriptions without a resultant increase in postoperative complications in pediatric patients.

Background: A lack of consensus exists regarding optimal postoperative pain management given the delicate balance between adequate pain control and minimizing serious risk associated with even short-term opioid prescription. Act 125 was signed into Pennsylvania law in November 2016, requiring parent or guardian consent for minors prescribed opioids, a seven-day prescription limit, and documented physician justification for use.

Study design: Retrospective cohort study of patients undergoing adenotonsillectomy six months before (211 patients) and after (112 patients) implementation of mandated opioid consent forms.

Setting: Department of Otolaryngology, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Penn.

Synopsis: There was no statistically significant difference in opioid prescription frequency following mandated consent form implementation. The mean total opioids prescribed was significantly higher pre-consent than post-consent, while the total number of days prescribed was lower in the post-consent group. There were no univariate differences between groups for postoperative number of nursing telephone calls, follow-up appointments, or ED visits. Older patients (5-17 years) were nine times more likely to be prescribed opioids than younger patients (0-4 years). Younger patients had no change in opioid prescription or postoperative outcomes post-consent, but older patients were more likely to be prescribed fewer opioids and have lower rates of hospital readmission and bleeding concern post-consent. Limitations include lack of information on whether opioid prescriptions were actually filled, the amount of oxycodone consumed, whether a change in total opioid prescription was attributable to changes in weight-based dosing, dosing schedule, or a combination, and medical record documentation of reasons for not prescribing opioids.

Citation: Whelan RI, McCoy J, Mirson L, Chi DH. Opioid prescription and postoperative outcomes in pediatric patients. Laryngoscope. 2019;129:1477–1481.