Comparing Provider and Adolescent Estimates of Postoperative Opioid Use

Introduction

Most adolescents report unused opioids after surgery. Current interventions compare opioid prescribing between surgeons without capturing actual patient-reported use.

Methods

We recruited pediatric surgery residents, fellows, advanced practitioners, and surgeons from four surgical divisions at a tertiary care children's hospital. Providers reviewed clinical vignettes based on adolescent-reported postoperative opioid use data from our institution. Afterward, providers were asked to select the number of opioid pills they would prescribe and compare their responses to adolescent-reported use. We then measured provider willingness to change prescribing practices based on this comparison.

Results

Overall, provider response rate was 41.3% (N = 38/92). Providers underestimated the number of opioids used for posterior spinal fusion, open pectus excavatum repair, open pectus carinatum repair, knee arthroscopy, and tonsillectomy and overestimated opioid use following hip reconstruction. Differences in median postoperative opioid use estimates from providers versus adolescent-reported use were significant for knee arthroscopy (10 interquartile range [IQR, 0-3] versus 3 IQR [1.5-13]; P < 0.001) and tonsillectomy (0 IQR [0-2.5] versus 1 IQR [0-7]; P = 0.043). Overall, general pediatric surgery providers underestimated opioid use while orthopedic and cardiothoracic providers overestimated opioid use. Differences between provider specialty were significant for posterior spinal fusion (P = 0.022), knee arthroscopy (P < 0.001), and tonsillectomy (P = 0.005). The number of opioids prescribed varied by provider role and 88.9% of providers (N = 32/36) reported that they would change prescribing habits based on adolescent reports.

Conclusions

There are differences in provider estimates of postoperative prescription opioid use versus adolescent-reported use. Fortunately, providers report a willingness to change prescribing practice based on these differences. Feedback incorporating patient-reported postoperative opioid use may be a more accurate and patient-centered way to decrease excess opioid prescribing.