09 Aug Tonsillectomy: Over Half of Children Have Opioid Prescription Filled
MedicalResearch.com Interview with:
Kao-Ping Chua, M.D., Ph.D.
Department of Pediatrics and Communicable Diseases
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan
Ann Arbor, Michigan
MedicalResearch.com: What is the background for this study?
Response: Tonsillectomy is one of the most common surgeries performed in children. It is also one of the most common reasons children are prescribed opioids, even though randomized trials suggest that non-opioids like ibuprofen are equally effective for pain control. We were interested in understanding whether it is possible to safely reduce opioid exposure after tonsillectomy in children without increasing the risk of complications such as emergency department visits for uncontrolled throat pain, which could lead to dehydration.
MedicalResearch.com: What are the main findings?
Response: Using national insurance claims data from 15,000 privately insured children undergoing tonsillectomy, we found that 6 in 10 children had a filled opioid prescription. Of the children who had a filled opioid prescription, the average size of the prescription was an eight-day supply, which could represent up to 48 doses of opioids – an amount that far exceeds the typical number of doses children need after tonsillectomy.
We found that having a filled opioid prescription and the size of these prescriptions were both not associated with the risk of subsequent return visits for pain or dehydration. However, having a filled opioid prescription was associated with an increased risk of return visits for constipation, and one child prescribed opioids subsequently overdosed.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest opportunities to reduce the number of children who are prescribed opioids after tonsillectomy, as well as opportunities to reduce the size of prescriptions in children to whom opioids are prescribed.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to collect more data on opioid use after tonsillectomy to develop evidence-based guidelines on how much opioid to prescribe to children, assuming they are prescribed opioids at all.
MedicalResearch.com: Is there anything else you would like to add?
Response: Parents of children scheduled to have tonsillectomy should know that national guidelines by the American Academy of Otolaryngology strongly recommend the use of non-opioids like ibuprofen as the first choice for pain control. That means that even if their child is prescribed opioids after surgery, they do not necessarily have to fill the prescription. If they do fill the prescription, they should only administer opioids when non-opioids are insufficient for pain.
Chua K, Harbaugh CM, Brummett CM, et al. Association of Perioperative Opioid Prescriptions With Risk of Complications After Tonsillectomy in Children. JAMA Otolaryngol Head Neck Surg. Published online August 08, 2019. doi:10.1001/jamaoto.2019.2107
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