Prescription Opioid Use for Adolescents With Neurocognitive Disability Undergoing Surgery: A Pilot Study

Olivia A Keane; Shadassa Ourshalimian; Marjorie Odegard; Rachel Y Goldstein; Lindsay M Andras; Eugene Kim; Lorraine I Kelley-Quon

doi:10.1016/j.jss.2023.06.007

Prescription Opioid Use for Adolescents With Neurocognitive Disability Undergoing Surgery: A Pilot Study

J Surg Res. 2023 Nov:291:237-244. doi: 10.1016/j.jss.2023.06.007. Epub 2023 Jul 19.

Authors

Olivia A Keane¹, Shadassa Ourshalimian², Marjorie Odegard³, Rachel Y Goldstein⁴, Lindsay M Andras⁴, Eugene Kim⁵, Lorraine I Kelley-Quon⁶

Affiliations

¹ Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: okeane@chla.usc.edu.
² Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
³ Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
⁴ Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, California.
⁵ Division of Pain Medicine, Children's Hospital Los Angeles, Los Angeles, California.
⁶ Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California.

PMID: 37478647
PMCID: PMC10578681 (available on 2024-11-01)
DOI: 10.1016/j.jss.2023.06.007

Abstract

Introduction: Parents frequently report retaining unused opioid pills following their child's surgery due to fear of untreated postoperative pain. Assessment of pain in adolescents with neurocognitive disability is challenging. We hypothesized that parents of adolescents with neurocognitive disability may report less opioid use and higher opioid pill retention.

Methods: Adolescents (13-20 y) undergoing elective surgery (posterior spinal fusion, hip reconstruction, arthroscopy, tonsillectomy) were prospectively enrolled from a tertiary children's hospital from 2019 to 2020. Only adolescents prescribed opioids at discharge were included. Parents completed a preoperative survey collecting sociodemographic characteristics and two postoperative surveys at 30- and 90-d. Neurocognitive disability was determined at time of enrollment by caregiver report, and included adolescents with cerebral palsy, severe autism spectrum disorder, and discrete syndromes with severe neurocognitive disability.

Results: Of 125 parent-adolescent dyads enrolled, 14 had neurocognitive disability. The median number of opioid pills prescribed at discharge did not differ by neurocognitive disability (29, interquartile range {IQR}: 20.0-33.3 versus 30, IQR: 25.0-40.0, P = 0.180). Parents of both groups reported similar cumulative days of opioid use (7.0, IQR: 3.0-21.0 versus 6.0, IQR:3.0-10.0, P = 0.515) and similar number of opioid pills used (4, IQR: 2.0-4.5 versus 12, IQR: 3.5-22.5, P = 0.083). Parents of both groups reported similar numbers of unused opioid pills (17, IQR: 12.5-22.5 versus 19, IQR: 8.0-29.0, P = 0.905) and rates of retention of unused opioids (15.4% versus 23.8%, P = 0.730).

Conclusions: The number of opioid pills prescribed did not differ by neurocognitive disability and parents reported similar opioid use and retention of unused opioid pills. Larger studies are needed to identify opportunities to improve postoperative pain control for children with neurocognitive disability.

Keywords: Adolescents; Neurocognitive disability; Opioids; Pain control; Postoperative; Prescription.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Analgesics, Opioid / therapeutic use
Autism Spectrum Disorder* / drug therapy
Child
Humans
Opioid-Related Disorders* / epidemiology
Opioid-Related Disorders* / etiology
Opioid-Related Disorders* / prevention & control
Pain, Postoperative / diagnosis
Pain, Postoperative / drug therapy
Pain, Postoperative / etiology
Pilot Projects
Practice Patterns, Physicians'
Prescriptions

Substances

Analgesics, Opioid

Grants and funding

KL2 TR001854/TR/NCATS NIH HHS/United States