Factors Associated with Postoperative Opioid Use in Adolescents.

ABSTRACT

BACKGROUND: We aimed to identify factors associated with postoperative prescription opioid use in adolescents. METHODS: Adolescents aged 13-20 years undergoing surgery were prospectively recruited from a children's hospital. Adolescent-parent dyads completed a preoperative survey, measuring clinical and sociodemographic factors, and two postoperative surveys evaluating self-reported opioid use at 30- and 90-days. Poisson regression analysis identified factors associated with the number of pills used within 90-days, adjusting for age, gender, race/ethnicity, surgery type, and pain at discharge. RESULTS: We enrolled 119 adolescents who reported postoperative opioid use following posterior spinal fusion (PSF) (50 %), arthroscopy (23 %), pectus excavatum repair (11 %), tonsillectomy (8 %), and hip reconstruction (7 %). Overall, 81 % of adolescents reported unused opioids. The median pain score at discharge was 7 (IQR5-8). Adolescents reported using a median of 7 (IQR2-15) opioid pills, with 20 (IQR7-30) pills left unused. Compared to all other surgeries, adolescents undergoing PSF reported the highest median pill use (10, IQR5-29; p = 0.004). Adolescents undergoing tonsillectomy reported the lowest median pill use (1, IQR0-7; p = 0.03). On regression analysis, older patient age was associated with a 12 % increase in pill use (95 % CI3%-23 %). Undergoing PSF was associated with a 63 % increase in pill use (95 % CI15%-31 %). Each additional pain scale point reported at discharge was associated with a 13 % increase in pill use (95 % CI5%-22 %). CONCLUSIONS: Older age, surgery type, and patient-reported pain at discharge are associated with postoperative prescription opioid use in adolescents. Understanding patient and surgery-specific factors associated with opioid use may guide surgeons to minimize excess opioid prescribing. LEVEL OF EVIDENCE II.