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Original Investigation
August 8, 2019

Association of Perioperative Opioid Prescriptions With Risk of Complications After Tonsillectomy in Children

Author Affiliations
  • 1Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
  • 2National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 3Department of Surgery, University of Michigan Medical School, Ann Arbor
  • 4Michigan Opioid Prescribing Engagement Network, Ann Arbor
  • 5Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
  • 6Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2019;145(10):911-918. doi:10.1001/jamaoto.2019.2107
Key Points

Question  Are perioperative opioid prescriptions or their duration associated with fewer or more return visits for complications after tonsillectomy in children than nonopiod use?

Findings  In this cohort analysis of 15 793 children who underwent tonsillectomy, having 1 or more perioperative opioid prescription fills was not associated with fewer or more return visits for pain or dehydration or secondary hemorrhage than nonopioid use, but it was associated with increased risk of return visits for constipation. Duration of perioperative opioid prescriptions was not associated with return visits for complications.

Meaning  These findings potentially support the feasibility of reducing perioperative opioid prescribing and prescription duration in children after tonsillectomy.

Abstract

Importance  Practice guidelines recommend nonopioid medications in children after tonsillectomy, but to date, studies have not used recent national data to assess perioperative opioid prescribing patterns or the factors associated with these patterns in this population. Closing this knowledge gap may help in assessing whether such prescribing and prescription duration could be safely reduced.

Objective  To assess national perioperative opioid prescribing patterns, clinical and demographic factors associated with these patterns, and association between these patterns and complications in children after tonsillectomy compared with children not using opioids.

Design, Setting, and Participants  This cohort analysis used the 2016 to 2017 claims data from the database of a large national private insurer in the United States. Opioid-naive children aged 1 to 18 years with a claims code for tonsillectomy with or without adenoidectomy between April 1, 2016, and December 15, 2017, were identified (n = 22 567) and screened against the exclusion criteria. The final sample included 15 793 children.

Main Outcomes and Measures  The percentage of children with 1 or more perioperative fills (prescription drug claims for opioids between 7 days before to 1 day after tonsillectomy) was calculated, along with the duration of perioperative prescriptions (days supplied). Linear regression was used to identify the demographic and clinical factors associated with the duration of perioperative opioid prescriptions. Logistic regression was used to assess the association between having 1 or more perioperative fills and their duration and the risk of return visits 2 to 14 days after tonsillectomy for pain or dehydration, secondary hemorrhage, and constipation compared with children not using opioids.

Results  Among 15 793 children, the mean (SD) age was 7.8 (4.2) years, 12 807 (81.1%) were younger than 12 years, 2986 (18.9%) were between 12 and 18 years of age, and 8289 (52.6%) were female. In total, 9411 (59.6%) children had 1 or more perioperative fills, and the median (25th-75th percentile) duration was 8 (6-10) days; 6382 had no perioperative fills. The probability of having 1 or more perioperative fills and the duration of prescription varied across US census divisions. Having 1 or more perioperative fills was not associated with return visits for pain or dehydration (adjusted odds ratio [AOR], 1.13; 95% CI, 0.95-1.34) or secondary hemorrhage (AOR, 0.90; 95% CI, 0.73-1.10) compared with children not using opioids, but it was associated with increased risk of return visits for constipation (AOR, 2.02; 95% CI, 1.24-3.28). Duration was not associated with return visits for complications.

Conclusions and Relevance  These findings suggest that reducing perioperative opioid prescribing and the duration of perioperative opioid prescriptions may be possible without increasing the risk of these complications.

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