Government Mandated Consent Dramatically Reduces Pediatric Urologist Opioid Utilization for Outpatient and Minor Emergency Surgeries

• Published in: The Journal of urology Vol. 205; no. 1; pp. 264 - 270
• Main Authors: Villanueva, Jeffrey, Grajales, Valentina, Colaco, Marc, Ayyash, Omar, Chaudhry, Rajeev, Schneck, Francis, Cannon, Glenn, Fox, Janelle
• Format: Journal Article
• Language: English
• Published: United States 01.01.2021
• Subjects: Ambulatory Surgical Procedures - adverse effects; Analgesics, Opioid - adverse effects; Analgesics, Opioid - standards; Child; Child, Preschool; Drug Utilization - legislation & jurisprudence; Drug Utilization - statistics & numerical data; Emergency Service, Hospital - statistics & numerical data; Emergency Treatment - adverse effects; Emergency Treatment - methods; Female; Humans; Infant; Informed Consent - legislation & jurisprudence; Informed Consent - standards; Male; Opioid Epidemic - prevention & control; Pain Management - methods; Pain Management - standards; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Patient Readmission - statistics & numerical data; Pennsylvania; Practice Patterns, Physicians' - legislation & jurisprudence; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; State Government; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - methods; Urologists - legislation & jurisprudence; Urologists - standards; Urologists - statistics & numerical data; Pennsylvania; postoperative; pain; analgesics; opioid
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1097/JU.0000000000001320

Postoperative opioids are overprescribed in the United States. In November 2016 the State of Pennsylvania required an opioid consent for minors. Our hypothesis is that this mandate decreased postoperative opioid prescriptions in our division. All patients who received a urological outpatient or minor emergency procedure from August 2015 to August 2019 were identified. Surgeries performed within 6 months after mandate implementation were excluded to account for the transition period. Perioperative data including case type were extracted by a clinical data warehouse from preexisting fields within the health record. The frequencies of postoperative prescriptions, delayed prescriptions and emergency department encounters were assessed. A multivariable logistic regression to identify predictors of opioid prescription at discharge was performed. A total of 4,349 patients were analyzed. The frequency of postsurgical opioid prescriptions decreased from 45.3% to 2.6% (p <0.001). The median morphine milligram equivalent decreased by 22.5 among children prescribed an opioid (p <0.001). Rates of an emergency department visits (3% vs 2.7%) or delayed nonopioid prescriptions (0.8% vs 1.2%) within 30 days of discharge were unchanged (p >0.05). Fewer patients received a delayed opioid prescription after mandate implementation (0.03% vs 0.5%, p <0.001). Female patients were less likely (OR 0.309, 95% CI 0.195-0.491; p <0.001) to receive opioids prior to but not after the mandate (OR 0.309, 95% CI 0.544-2.035; p=0.122). Increasing age was predictive of receiving an opioid before (OR 1.187, 95% CI 1.157-1.218; p <0.001) and after (OR 1.241, 95% CI 1.186-1.299; p <0.001) the mandate. A state mandated opioid consent for minors greatly reduced post-urological surgery opioid prescription rates without increasing rates of readmission or delayed prescriptions.