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Association of Perioperative Opioid Prescriptions With Risk of Complications After Tonsillectomy in Children

Educational Objective
To assess the association between perioperative opioid prescriptions and return visits as well as secondary hemorrhage.
1 Credit CME
Key Points

Question  Are perioperative opioid prescriptions or their duration associated with fewer or more return visits for complications after tonsillectomy in children than nonopiod use?

Findings  In this cohort analysis of 15 793 children who underwent tonsillectomy, having 1 or more perioperative opioid prescription fills was not associated with fewer or more return visits for pain or dehydration or secondary hemorrhage than nonopioid use, but it was associated with increased risk of return visits for constipation. Duration of perioperative opioid prescriptions was not associated with return visits for complications.

Meaning  These findings potentially support the feasibility of reducing perioperative opioid prescribing and prescription duration in children after tonsillectomy.


Importance  Practice guidelines recommend nonopioid medications in children after tonsillectomy, but to date, studies have not used recent national data to assess perioperative opioid prescribing patterns or the factors associated with these patterns in this population. Closing this knowledge gap may help in assessing whether such prescribing and prescription duration could be safely reduced.

Objective  To assess national perioperative opioid prescribing patterns, clinical and demographic factors associated with these patterns, and association between these patterns and complications in children after tonsillectomy compared with children not using opioids.

Design, Setting, and Participants  This cohort analysis used the 2016 to 2017 claims data from the database of a large national private insurer in the United States. Opioid-naive children aged 1 to 18 years with a claims code for tonsillectomy with or without adenoidectomy between April 1, 2016, and December 15, 2017, were identified (n = 22 567) and screened against the exclusion criteria. The final sample included 15 793 children.

Main Outcomes and Measures  The percentage of children with 1 or more perioperative fills (prescription drug claims for opioids between 7 days before to 1 day after tonsillectomy) was calculated, along with the duration of perioperative prescriptions (days supplied). Linear regression was used to identify the demographic and clinical factors associated with the duration of perioperative opioid prescriptions. Logistic regression was used to assess the association between having 1 or more perioperative fills and their duration and the risk of return visits 2 to 14 days after tonsillectomy for pain or dehydration, secondary hemorrhage, and constipation compared with children not using opioids.

Results  Among 15 793 children, the mean (SD) age was 7.8 (4.2) years, 12 807 (81.1%) were younger than 12 years, 2986 (18.9%) were between 12 and 18 years of age, and 8289 (52.6%) were female. In total, 9411 (59.6%) children had 1 or more perioperative fills, and the median (25th-75th percentile) duration was 8 (6-10) days; 6382 had no perioperative fills. The probability of having 1 or more perioperative fills and the duration of prescription varied across US census divisions. Having 1 or more perioperative fills was not associated with return visits for pain or dehydration (adjusted odds ratio [AOR], 1.13; 95% CI, 0.95-1.34) or secondary hemorrhage (AOR, 0.90; 95% CI, 0.73-1.10) compared with children not using opioids, but it was associated with increased risk of return visits for constipation (AOR, 2.02; 95% CI, 1.24-3.28). Duration was not associated with return visits for complications.

Conclusions and Relevance  These findings suggest that reducing perioperative opioid prescribing and the duration of perioperative opioid prescriptions may be possible without increasing the risk of these complications.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: June 8, 2019.

Corresponding Author: Kao-Ping Chua, MD, PhD, Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N Ingalls St, SPC 5456, Room 6E18, Ann Arbor, MI 48109-5456 (

Published Online: August 8, 2019. doi:10.1001/jamaoto.2019.2107

Author Contributions: Dr Chua had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chua, Brummett, Thatcher.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chua, Brummett.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Chua, Brummett.

Obtained funding: Brummett.

Administrative, technical, or material support: Brummett, Brenner.

Supervision: Brummett, Bohm, Thatcher, Brenner.

Conflict of Interest Disclosures: Dr Brummett reported having a patent for peripheral perineural dexmedetomidine licensed to the University of Michigan; serving as a consultant for Recro Pharma and Heron Therapeutics Inc outside of the present work; receiving research funding from Neuros Medical Inc; and receiving grants from the National Institutes of Health-US Department of Health and Human Services, Michigan Department of Health and Human Services, National Institute on Drug Abuse, and University of Michigan Genomics Initiative during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was funded in part by career development award 1K08DA048110-01 from the National Institute on Drug Abuse (Dr Chua) and grant E20180568-001 from the Substance Abuse and Mental Health Services Administration and grant E20180672-00 from the Centers for Medicare & Medicaid Services (Dr Brummett).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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