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

Abstract

IntroductionThe overprescription of opioids for pediatric orthopedic surgery patients is a concerning issue due to 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 orthopedic procedures. MethodsWe 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 orthopedic 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. ResultsThe search identified 14 eligible studies encompassing a range of orthopedic 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. ConclusionThis review describes current postoperative opioid prescription patterns and utilization rates for a range of pediatric orthopedic surgeries. Our results suggest variability in opioid prescriptions and the potential for overprescription across many pediatric orthopedic 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 non-opioid analgesics and providing education on proper opioid use and disposal could further mitigate hazards. Level of EvidenceII