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Enhanced Recovery After Surgery Protocols Can Vastly Decrease Rates Of Outpatient Opiate Prescribing In Pediatric Plastic Surgery Patients
Colton Fernstrum, MD, Samantha D. Morin, BS, BA, Benjamin C. McIntyre, MD, Laura S. Humphries, MD, FACS, Ian C. Hoppe, MD.
University of Mississippi Medical Center, Jackson, MS, USA.
PURPOSE:Enhanced recovery after surgery (ERAS) protocols decrease inpatient opiate usage after pediatric plastic surgery. This study analyzes the lead author’s ERAS protocols and their impact on outpatient opiate prescribing rates compared to other participating United States hospitals using the 2023 ACS NSQIP Pediatric Opiate Stewardship report.
METHODS:In 2018, ERAS protocols were established at the lead author’s institution for cleft lip and palate repair, alveolar bone grafting, surgery for velopharyngeal insufficiency (VPI), all cranial remodeling procedures, mandibular distraction osteogenesis, breast reductions, and minor lesion or mass excisions. Patients are not prescribed outpatient opiates for cleft lip repair, cranial springs placement and removal, mandibular distraction osteogenesis, or minor lesion/mass excision.
RESULTS:Of the pediatric plastic surgery postoperative patients, only 10.96% were prescribed outpatient opiates compared to 51.81% of pediatric plastic surgery postoperative patients at other NSQIP participating centers. In adolescents (12-17 years old), 23.81% of patients were prescribed opiates versus 63.20% at other facilities. Children aged 5-11 years old had opiates prescribed 5.88% of the time versus 52.82% at other facilities. 6.45% of infants and small children (0-4 years old excluding neonates) were prescribed opiates at the author’s institution compared to 45.85% at NSQIP participating centers. Finally, no neonates received outpatient opiates at this institution versus 13.83% at other centers.
CONCLUSION:There remains a trend in pediatric plastic surgery to prescribe outpatient opiates to most postoperative patients. Implementing ERAS protocols for commonly performed procedures can help reduce the number of postoperative patients receiving opiate prescriptions.
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