Patient-Reported Outcomes in Pain Management after Ambulatory Pediatric General and Urologic Surgery Utilizing Opioid Stewardship Strategies


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Presentation: 8:17

Mentor: Loren Berman, MD, Pediatric Surgery, Nemours Children’s Hospital


Background: The opioid epidemic remains a critical public health issue in the United States. Many studies evaluating the impact of opioid stewardship on post-operative pain rely on emergency room visits or readmissions, but patient-reported pain scores represent a more complete picture of the post-operative experience. This study compares patient-reported pain scores after ambulatory general pediatric and urologic procedures in patients receiving non-opioid (acetaminophen and ibuprofen) versus opioid-containing regimens.

Methods: A retrospective chart review was conducted for 2,033 pediatric patients undergoing ambulatory procedures from 2015-2019, a time frame during which there was a dedicated effort to reduce narcotic prescriptions. Patients were called on post-operative day one to assess pain levels using a four-point scale (no pain, mild pain, moderate pain controlled with medication, or severe pain uncontrolled with medication). We compared pain scores for patients receiving opioid versus non-opioid regimens. Subgroup analyses were conducted by procedure.

Results: Opioid prescription rates reduced significantly during the time span of the study due to opioid stewardship efforts. The majority of patients (1,698) received non-opioids, with only 335 patients receiving opioids. There were no significant differences between groups in terms of age, race, ASA classification, and insurance status. Opioid patients reported moderate/severe pain slightly more often than non-opioid patients (14.1% vs. 10.0%, p=0.03). On procedure-specific analyses, there were no subgroups in which patients without opioids had significantly higher pain scores.

Conclusions: Non-opioid post-operative pain regimens appear to be effective, with only 10% of patients reporting moderate/severe pain after ambulatory procedures. Future studies assessing patient-reported outcomes are necessary to optimize pain control for all patients and to determine whether



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