Effect of otolaryngology analgesia guidelines on opioid prescribing in pediatric tonsillectomy.

INTRODUCTION

Increasing opioid-related complications prompted the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) to issue specialty-specific clinical practice guidelines encouraging opioid prescription reduction in April of 2021. Opioids are frequently prescribed to pediatric patients after tonsillectomy for significant post-surgical pain. This study aimed to evaluate national changes in opioid prescribing rates in these patients after recommendation changes and also characterize associated demographic and procedure-related factors.

METHODS

The TriNetX US Database was queried for all patients under 18 years of age who underwent tonsillectomy with or without adenoidectomy between April 2018 and March 2024. Patients were stratified by those with and without peri-operative opioid prescriptions. Demographic data was assessed with descriptive statistics and paired t-tests. An interrupted time series analysis regression was executed to evaluate the impact of the intervention on prescribing rates after April 2021.

RESULTS

Of the 95,861 pediatric tonsillectomy patients identified, 32,986 (34.4 %) received a peri-operative opioid prescription. Opioids prescription rates were lower amongst Black patients (26.2 %) than White (35.5 %) or Asian (38.3 %) patients. There was a significant decrease in overall opioid prescription rate trends before and after guideline statements. Specifically, prescription rates significantly decreased by 1.09 % per 6-month interval in the pre-guideline period (p = 0.050) and by 6.99 % immediately post-guideline (p = 0.008).

CONCLUSION

Clinical practice guidelines have played a significant role in decreasing overall opioid prescription rates after adenotonsillectomy. In instances where opioid use may still be necessary based on patient-specific needs, our findings advocate for equitable and effective pain management.

LEVEL OF EVIDENCE: III.