Multicenter Evaluation of Opioid Prescribing After Minimally Invasive Repair of Pectus Excavatum Before The 2024 American Academy of Pediatrics Guideline: Room to Improve.

INTRODUCTION

To better understand baseline prescribing patterns before the release of the American Academy of Pediatrics (AAP)'s 2024 clinical guidelines on opioid prescribing, we evaluated the degree to which discharge pain management practices following minimally invasive repair of pectus excavatum (MIRPE) aligned with AAP's recommendations across 10 children's hospitals.

METHODS

Patients aged ≤21 y who underwent MIRPE (January 2022 to October 2023) were retrospectively reviewed. Those who underwent MIRPE for recurrent disease or underwent concurrent procedure(s) at the time of repair were excluded. Descriptive statistics were used to summarize findings.

RESULTS

A total of 528 patients were analyzed. The median preoperative Haller Index was 4.5 (interquartile range [IQR] 3.8, 5.7) and Correction Index was 33.0% (IQR 26.2%, 43.2%). One bar was placed in 50% of patients, two bars in 47.5% of patients, and three bars in 2.5% of patients. Cryoablation was used in 90% of patients, and 3.6% received subcutaneous pain pumps. The median hospital length of stay was 1 d (IQR 1.0, 2.0). Nearly all patients were discharged with nonopioid analgesics: acetaminophen (98.9%), nonsteroidal anti-inflammatory drugs (97.9%); 31.8% were prescribed gabapentin. Opioids were prescribed for 494 (93.6%) patients, with 95.5% of prescriptions written for fewer than 5 d. No patients received tramadol, codeine, opioid monotherapy, or long-acting opioids. Naloxone was prescribed for 37 (7.0%) patients. Co-prescription of opioids with benzodiazepines and/or muscle relaxants occurred in 79.7% of cases.

CONCLUSIONS

Baseline discharge analgesic prescribing practices following MIRPE only partially aligned with AAP's guidelines. Opportunities for improvement include prescribing naloxone with opioids and reduction in co-prescription of sedating medications.