• Profile
Close

Six in ten children receive opioids after tonsillectomy: JAMA

ScienceDaily Aug 14, 2019

Sixty percent of privately insured children undergoing tonsil removal received opioids—with average prescriptions lasting about 6 to 10 days—a new study finds.

And while the more powerful painkillers are often prescribed because they have been believed to reduce the risk of complications such as poorly controlled pain, researchers did not find evidence indicating that opioids protected children against those risks. The Michigan Medicine study appears in the journal JAMA Otolaryngology-Head & Neck Surgery.

"Our findings suggest that it may be possible to reduce opioid exposure among children who undergo this common surgery without increasing the risk of complications," says lead author Kao-Ping Chua, MD, PhD, a researcher and pediatrician at University of Michigan C. S. Mott Children's Hospital and the U-M Institute for Healthcare Policy and Innovation.

Researchers analyzed national data between 2016 and 2017 from a private insurance database. Among 15,793 children (ages 1 to 18) who underwent a tonsillectomy, 6 in 10 had one or more filled opioid prescriptions.

Tonsillectomy is one of the most common surgical procedures performed in children. American Academy of Otolaryngology guidelines strongly recommend non-opioids, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, for these procedures.

Chua says there are several possible explanations for why so many children still received opioid prescriptions despite these guidelines. Among the biggest potential reasons is that the potent painkillers have been believed to provide superior pain relief and reduce risk of return visits for uncontrolled pain leading to dehydration.

In the University of Michigan study, having a filled opioid prescription wasn't associated with a difference in risk of return visits for pain or dehydration. But it was linked to an increased risk of constipation and, in at least one case, an opioid overdose, the study found.

Chua believes surgeons may also prescribe opioids after tonsillectomy because they fear that NSAID use increases bleeding risk. But clinical trials have not demonstrated a significant increase in bleeding risk with NSAID use. In the new Michigan study, having a filled opioid prescription was not associated with a decreased risk of bleeding, suggesting that prescribing opioids may not protect against this complication.

Among children with perioperative fills, the median prescription duration was 8 days, an amount that could represent 48 doses of opioids. This is far greater than what the average patient needs, researchers say. A previous study at Mott found that children undergoing tonsillectomy in 2013 were prescribed an average of 52 opioid doses but had an average of 44 leftover opioid doses.

Over-prescribing opioids to children isn't just a health risk to children, Chua says, but also to family and friends who may have access to the leftover opioids, which may not be properly disposed.

"To minimize the risks of opioids to children and their families, clinicians should rely on non-opioids when possible. When opioids are used, clinicians should aim to prescribe only the amount that patients need," Chua says.

"However, our study suggests that many children receive opioid prescriptions after tonsillectomy and that the amount of opioids in these prescriptions may be excessive. We need to conduct research to identify interventions that safely and effectively reduce opioid exposure for these children."

Go to Original
Only Doctors with an M3 India account can read this article. Sign up for free or login with your existing account.
4 reasons why Doctors love M3 India
  • Exclusive Write-ups & Webinars by KOLs

  • Nonloggedininfinity icon
    Daily Quiz by specialty
  • Nonloggedinlock icon
    Paid Market Research Surveys
  • Case discussions, News & Journals' summaries
Sign-up / Log In
x
M3 app logo
Choose easy access to M3 India from your mobile!


M3 instruc arrow
Add M3 India to your Home screen
Tap  Chrome menu  and select "Add to Home screen" to pin the M3 India App to your Home screen
Okay