Opioids after pediatric tonsillectomy: are they necessary?

  • Chua KP & al.
  • JAMA Otolaryngol Head Neck Surg
  • 8 Aug 2019

  • International Clinical Digest
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Takeaway

  • After tonsillectomy in children, perioperative opioid prescriptions show no link to number of return visits for complications, with the exception of increased returns for constipation.

Why this matters

  • Guidelines call for nonopioids as first-line choice for these children.
  • These authors say that their findings support the possibility that opioid prescriptions and their duration can be reduced in this population.

Key results

  • 59.6% of the children had 1+ perioperative fills.
  • Perioperative opioid medication refills were not associated (aORs; 95% CIs) with return visits for:
    • Pain/dehydration: 
      • 4.1% no refills vs 4.3% any;
      • 1.13 (0.95-1.34); or
    • Secondary hemorrhage: 
      • 2.9% no refills vs 3.2% any;
      • 0.90 (0.73-1.10).
  • 1+ refills was associated with returns for constipation: 
    • 0.4% with no refills vs 0.7% with any;
    • aOR, 2.02 (95% CI, 1.24-3.28).
  • Duration of prescription was not associated with any return visit categories evaluated.
  • 1 child had a return visit for opioid overdose.

Study design

  • Cohort study of insurance claims data for 22,567 children (mean age, 7.8 years) undergoing tonsillectomy, 2016-2017.
  • Return window evaluated was 2-14 days post-op.
  • Funding: National Institute on Drug Abuse, others.

Limitations

  • Unmeasured confounding possible.
  • Usual limitations of database information, including tracking only refills filed for insurance.