PD60-06 OMISSION OF AMBULATORY NARCOTICS IS SAFE AFTER THE MAJORITY OF INPATIENT PEDIATRIC UROLOGIC SURGERIES

Abstract

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making V (PD60)1 Sep 2021PD60-06 OMISSION OF AMBULATORY NARCOTICS IS SAFE AFTER THE MAJORITY OF INPATIENT PEDIATRIC UROLOGIC SURGERIES Jeffrey Villanueva, Benjamin Pifer, Marc Colaco, Valentina Grajales, Omar Ayyash, Rajeev Chaudhry, Francis Schneck, Glenn Cannon, and Janelle Fox Jeffrey VillanuevaJeffrey Villanueva More articles by this author , Benjamin PiferBenjamin Pifer More articles by this author , Marc ColacoMarc Colaco More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Omar AyyashOmar Ayyash More articles by this author , Rajeev ChaudhryRajeev Chaudhry More articles by this author , Francis SchneckFrancis Schneck More articles by this author , Glenn CannonGlenn Cannon More articles by this author , and Janelle FoxJanelle Fox More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002097.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Opiate overdose has reached epidemic levels in the United States, and as such several states have implemented various strategies to curb usage. In November 2016 Pennsylvania passed Act 125 requiring written consent when prescribing opiates to a minor and limiting opiate prescriptions to a seven day course. The purpose of this study is to examine the effect of this state mandate on narcotic utilization and pain related outcomes after inpatient pediatric urologic surgeries. METHODS: A retrospective analysis was performed examining all patients who underwent inpatient pediatric urologic surgery at the Children’s Hospital of Pittsburgh between August 2015 and February 2020. Subjects were separated into pre-mandate and post-mandate cohorts (subtracting a 6 month window immediately after November 2016 to account for transition). We then assed the frequency of inpatient and ambulatory opiate utilization between cohorts as well as the use of alternative pain management approaches. Frequencies of adverse events including delayed prescriptions or emergency department visits within 30 days were also identified. RESULTS: After accounting for a 6-month transition period following policy implementation, 462 major pediatric urologic procedures were identified. The frequency of discharge opiate prescriptions decreased from 68.4% prior to the transition period to 10.7% afterward (p <0.001). Morphine milligram equivalents per prescription decreased from 75(IQR 45-150) to 45(IQR 22.5-75) (p <0.001). There was no change in the rate of delayed non-opioid analgesic prescriptions (6.6 % vs 7.4%), delayed opioid prescriptions (1.5% vs 0.3%), or emergency department visits (11.8% vs 12.6%) (p=0.809). The effect of the intervention was durable, where 1.7% of major pediatric urologic surgeries in the final 12 months of the study were discharged with an opioid. CONCLUSIONS: Omission of ambulatory narcotics is safe for most major pediatric urologic surgeries and does not require an increase in regional anesthesia utilization. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1062-e1062 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Villanueva More articles by this author Benjamin Pifer More articles by this author Marc Colaco More articles by this author Valentina Grajales More articles by this author Omar Ayyash More articles by this author Rajeev Chaudhry More articles by this author Francis Schneck More articles by this author Glenn Cannon More articles by this author Janelle Fox More articles by this author Expand All Advertisement Loading ...