Provider education decreases opioid prescribing after pediatric umbilical hernia repair

Pediatric Surgical Research Collaborative - PedSRC

Research output: Contribution to journalArticle

Abstract

Purpose: To improve opioid stewardship for umbilical hernia repair in children. Methods: An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared. Results: A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001)post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18–0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts. Conclusions: Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention. Type of Study: Retrospective cohort study. Level of Evidence: Level II.

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StatePublished - Jan 1 2019

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Umbilical Hernia
Herniorrhaphy
Opioid Analgesics
Pediatrics
Education
Patient Readmission
Morphine
Analgesics
Hospital Emergency Service
Cohort Studies
Retrospective Studies
Odds Ratio
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Provider education decreases opioid prescribing after pediatric umbilical hernia repair. / Pediatric Surgical Research Collaborative - PedSRC.

In: Journal of pediatric surgery, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Provider education decreases opioid prescribing after pediatric umbilical hernia repair",
abstract = "Purpose: To improve opioid stewardship for umbilical hernia repair in children. Methods: An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared. Results: A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8{\%} pre-intervention to 44.6{\%} (p < 0.001)post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95{\%} CI = 0.18–0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts. Conclusions: Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention. Type of Study: Retrospective cohort study. Level of Evidence: Level II.",
author = "{Pediatric Surgical Research Collaborative - PedSRC} and Piper, {Kaitlin N.} and Baxter, {Katherine J.} and Martha Wetzel and Courtney McCracken and Curtis Travers and Bethany Slater and Cairo, {Sarah B.} and Rothstein, {David H.} and Robert Cina and Melvin Dassinger and Patrick Bonasso and Aaron Lipskar and Denning, {Naomi Liza} and Eunice Huang and Eunice Huang and Cunningham, {Megan E.} and Raquel Gonzalez and Kauffman, {Jeremy D.} and Heiss, {Kurt F.} and Raval, {Mehul V.}",
year = "2019",
month = "1",
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T1 - Provider education decreases opioid prescribing after pediatric umbilical hernia repair

AU - Pediatric Surgical Research Collaborative - PedSRC

AU - Piper, Kaitlin N.

AU - Baxter, Katherine J.

AU - Wetzel, Martha

AU - McCracken, Courtney

AU - Travers, Curtis

AU - Slater, Bethany

AU - Cairo, Sarah B.

AU - Rothstein, David H.

AU - Cina, Robert

AU - Dassinger, Melvin

AU - Bonasso, Patrick

AU - Lipskar, Aaron

AU - Denning, Naomi Liza

AU - Huang, Eunice

AU - Huang, Eunice

AU - Cunningham, Megan E.

AU - Gonzalez, Raquel

AU - Kauffman, Jeremy D.

AU - Heiss, Kurt F.

AU - Raval, Mehul V.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To improve opioid stewardship for umbilical hernia repair in children. Methods: An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared. Results: A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001)post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18–0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts. Conclusions: Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention. Type of Study: Retrospective cohort study. Level of Evidence: Level II.

AB - Purpose: To improve opioid stewardship for umbilical hernia repair in children. Methods: An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared. Results: A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001)post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18–0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts. Conclusions: Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention. Type of Study: Retrospective cohort study. Level of Evidence: Level II.

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U2 - 10.1016/j.jpedsurg.2019.04.035

DO - 10.1016/j.jpedsurg.2019.04.035

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JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

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