Perioperative Opioids Prescribing after Pediatric Urology Procedures is Associated With Persistent Opioid Use Disorder - A Large Claims Database Analysis
A. Grutman1, C. Stewart2, P. Agrawal1, C. Able2, L. Galansky3, A. Gabrielson3, N. Haney3, T. Kohn3, C. Crigger3
1Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX, USA; 3The James Buchanan Brady Urological Institute, Baltimore, MD, USA
Introduction and Objective: Despite increased cognizance of the detrimental effects of opioid exposure, opioids continue to be prescribed by pediatric surgeons for a variety of inpatient and outpatient procedures. This study aimed to assess the risk of persistent opioid use associated with various pediatric urologic procedures.
Methods: The TriNetX LLC Diamond Network was queried for patients aged 13 to 21 years who underwent six urologic procedures (pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision) and created cohorts of patients who were or were not prescribed postoperative opioids. Propensity matched scoring was performed for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses. The primary outcome was new persistent opioid use, defined as new opioid use 3-9 months after index procedure without another surgery requiring anesthesia during the post-operative timeframe.
Results: Overall, we identified 32,789 patients of whom 66.0% received a perioperative opioid prescription. After propensity score matching, 18, 416 patients were included: 197 for pyeloplasty, 469 for hypospadias repair, 1,818 for inguinal hernia repair, 2,664 for inguinal orchiectomy, 534 for hydrocelectomy, and 3,526 for circumcision. Overall, 0.41% of patients who did not receive perioperative opioids developed new persistent opioid use, whereas 1.69% of patients who received perioperative opioids developed new persistent opioid use (p<0.05). Patients who received perioperative opioids had statistically higher odds of developing new persistent opioid use after hypospadias repair (Risk Ratio (RR): 17.0; 95% Confidence Interval (CI): 2.27-127.2), inguinal orchiectomy (RR: 3.46; 95% CI: 1.87-6.4), inguinal hernia repair (RR: 2.18; 95% CI: 1.07-4.44), and circumcision (RR: 4.83; 95% CI: 2.60-8.98). There was no significant risk of developing new persistent opioid use with prescription of perioperative opioids following pyeloplasty or hydrocelectomy.
Conclusions: We found that the use of perioperative opioids in several pediatric urological procedures is associated with a significant risk of developing new persistent opioid use.