Postoperative Opioid Prescription Practices at Discharge for Pediatric Orthopaedic Patients: A Systematic Review

Abstract

The overprescription of opioids for pediatric orthopaedic surgery patients is a concerning issue due to the risks of misuse, diversion, and prolonged use. Despite this, evidence-based guidelines for opioid prescribing in this population are lacking. This systematic review aimed to characterize current opioid prescription practices and utilization following pediatric orthopaedic procedures. We conducted a systematic literature search in October 2023 using PubMed, MEDLINE, Embase, and additional sources to identify studies reporting on opioid prescriptions at discharge for pediatric orthopaedic patients. Included studies were from the United States describing the quantity prescribed and/or utilized. Mean prescription quantities and utilization rates were extracted, with opioid dosages converted to morphine milligram equivalents when possible. The search identified 14 eligible studies encompassing a range of orthopaedic procedures including spinal fusion, fracture repairs, and arthroscopy. Substantial variation existed in mean prescription quantities both across and within procedure types. Mean prescriptions ranged from no opioids for certain closed reductions to 61 pills for posterior spinal fusion. However, opioid utilization rates were generally low, with under 60% of prescribed pills taken in most studies. The highest utilization was 90.2% following spinal fusion, while the lowest was 7% for forearm fracture reductions when prescribed. Overall, lower prescription quantities and utilization rates were seen for less invasive procedures. This review describes current postoperative opioid prescription patterns and utilization rates for a range of pediatric orthopaedic surgeries. Our results suggest variability in opioid prescriptions and the potential for overprescription across many pediatric orthopaedic procedures, highlighting a need for standardized, procedure-specific prescribing recommendations. Prescribing lower opioid quantities aligned with anticipated medication requirements may reduce risks of misuse and diversion. Incorporating nonopioid analgesics and providing education on proper opioid use and disposal could further mitigate hazards. Key Concepts: (1) There was considerable variation in opioid prescription quantities across different pediatric orthopaedic procedures, ranging from no opioids prescribed for some minor procedures to over 60 pills for more invasive surgeries like spinal fusion. (2) Despite often receiving substantial opioid prescriptions, the reported utilization rates were generally low, with most studies showing less than 60% of prescribed opioid pills actually being taken by patients. (3) This discrepancy between prescribed amounts and actual utilization points toward potential overprescription of opioids for many pediatric orthopaedic procedures. (4) The findings highlight the need for standardized, procedure-specific opioid prescribing guidelines in pediatric orthopaedics to align prescriptions with anticipated analgesic requirements.

Keywords

• Pediatric orthopaedic surgery
• Postoperative opioid prescription
• Postoperative opioid utilization