Patient and Provider Education Safely Reduces Opioid Prescribing After Pediatric Urologic Surgery

Abstract

ObjectiveTo examine current opioid prescribing and determine what clinical factors were associated with use of opioids after urologic surgery after a previous study from our institution found that education regarding opioid prescribing practices significantly decreased post-operative opioid prescriptions from 61% to 34% (p<0.0001). MethodsFrom 2017 to 2023, a questionnaire querying what medications were used for postoperative pain was administered to patients/families at a postoperative visit. Survey results and demographic factors were obtained via retrospective chart review. Fisher’s exact and t-tests compared patients who did and did not use opioids. Results1,630 patients’ families completed a survey, with mean age 5.3 years, 95% male. Over the study period 550 patients (34%) were prescribed opioids and 474/1,630 (29%) used opioids post-operatively. Patients who used opioids were significantly older (7 vs 4 years, p<0.0001). Endoscopic surgery (p=0.0005), buried penis/torsion/chordee repair (p<0.0001), meatoplasty/skin bridge (p<0.0001), and alternating acetaminophen and ibuprofen (p<0.0001) were associated with decreased opioid use. Families of patients who used opioids had higher rates of calling clinic (6% vs 2%, p=0.0011) and visiting the Emergency Department (ED) with pain concerns (3% vs 0.7%, p=0.002). In 2017, 63% of patients were prescribed opioids after surgery compared with 6% in 2023 (p<0.0001). ConclusionsMost pediatric urologic surgeries can be performed without outpatient post-operative opioids. After education, we decreased opioid prescribing to only 5% of patients. The patients who were prescribed opioids had higher rates of ED visits or calling the clinic nurses with pain concerns.