Pain management after pediatric adenotonsillectomy: Do opioids influence healthcare utilization?

Introduction

Adenotonsillectomy (AT) is one of the most common outpatient pediatric surgical procedures in the United States. Due to the risks of opioids, guidelines recommend multimodal pain regimens. This study aims to assess differences in healthcare utilization in pediatric postoperative AT patients by postoperative medication regimen.

Methods

A retrospective cohort of 699 patients aged 3–18 years who underwent AT from December 2015 to March 2017 was analyzed. Patients were stratified into young children (3–4 years), children (5–12 years), and adolescents (≥13 years). Non opioid regimens of acetaminophen and ibuprofen were recommended for all. Some patients also received an opioid prescription. Total calls made, calls made regarding pain/dehydration (P/D), and ED visits were recorded.

Results

There was no significant correlation between opioid prescriptions and calls nor ED visits for P/D in patients ≥5 years. In young children, non-opioid prescriptions were associated with a higher likelihood of any phone call (p = 0.049). White patients had a significantly higher rate of phone calls (p = 0.0183). White and unknown-race patients made significantly more calls (p < 0.001) related to P/D. No racial differences were observed in ED visits.

Conclusion

Limiting opioid prescriptions in pediatric AT patients does not appear to impact healthcare utilization. However, in young children, opioid use correlated with fewer phone calls, though not specifically related to P/D. Future prospective studies documenting pain scores and medication administration would more accurately explore the optimization of pain control in pediatric patients after AT.