Vascular Stippling May Inform Diagnostic Sampling of Suspicious Laryngeal Lesions

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.