Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P127

Oral Presentations

Opioid Prescribing Patterns After Pediatric
Otolaryngology Procedures
Derek J. Lam, MD, MPH (Presenter); Jennifer J. Shin, MD, SM;
Hillary Mulder, MS; Vikas Mehta, MD
Objectives: (1) Describe the opioid prescribing patterns after
pediatric otolaryngology procedures. (2) Understand the
trends in opioid prescribing during the study period. (3)
Compare differences in opioid prescribing patterns by age
group.
Methods: This was a retrospective cohort study involving a
national insurance claims database. The proportion of children
(< 18 years of age) with filled opioid prescriptions after a
broad range of otolaryngology surgeries was assessed. To
place these results into context, the proportion of children
with filled opioid prescriptions after diagnostic procedures
was also evaluated. Opioid prescription usage was stratified
by age group, calendar year, and type of procedure.
Results: Among the 369,546 children who underwent otolaryngology surgery (group 1, median age 7 years), 98,793
(26.7%) filled an opioid prescription. The most commonly
used agents were hydrocodone (62.8%), codeine (30.0%),
and oxycodone (7.8%), and there was substantial variation
with age and procedure. Opioid fills were most common
after tonsillectomy (79%) and nasal airway procedures
(76%). Opioid prescriptions were filled for 75% of children
undergoing hearing device implantation, 70% after mastoidectomy, and 18% after frenectomy. Opioid usage was higher
in children 3 years and older compared with those younger
than 3 years of age (31% vs 15%, respectively). Prescriptions
decreased over the interval between 2011 and 2014. Among
the 507,146 children who underwent diagnostic procedures
(group 2, median age 8 years), 4864 (1.0%) filled an opioid
prescription. Nonopioid analgesic prescriptions were filled
for 4185 (1.1%) of those in group 1 and 2644 (0.5%) in
group 2.
Conclusions: Opioid usage varies after otolaryngology surgery in children. There may be opportunities to more optimally use opioids in children.

Opioid Prescribing Practices for Pediatric
Tonsillectomy Before and After Policy
Interventions
Daniel I. Gerges, MD (Presenter); Nicole Wershoven;
Heather C. Herrington, MD
Objectives: Efforts are being made at systems levels across
the country to decrease excess opioid prescribing. The purpose of this study was to investigate opioid prescribing practices after pediatric tonsillectomy in the year before and the
year after implementation of state and organizational policy
interventions in Vermont.
Methods: This is a retrospective chart review of pediatric
patients (younger than 18 years) who underwent tonsillectomy or adenotonsillectomy at a tertiary medical center 1 year
before (July 2016-June 2017) and 1 year after (July 2017June 2018) the implementation of policy interventions targeted at opioid prescribing. Data collected included
demographics, procedure performed, indication, complications, medical comorbidities, opioid-prescribing practices
(medication, dose, morphine milliequivalents, and postdischarge opioid prescriptions), and postoperative telephone
calls and emergency department (ED) visits.
Results: Tonsillectomy or adenotonsillectomy was performed in 360 patients (185 in the pre-policy year; 175 in the
postpolicy year). Those receiving an opioid prescription in the
prepolicy compared with the postpolicy year were 49.7% vs
14.5% (P < .001). Of patients age 6 years and older, 95.8% in
the prepolicy year compared with 25.2% in the postpolicy
year received a postoperative opioid (P < .001). There was no
difference in pain-related office telephone calls, postdischarge
opioid prescriptions, or ED visits between the 2 groups.
Conclusions: Implementation of statewide and organizational policy interventions can have a substantial impact on
opioid prescribing practices in the pediatric tonsillectomy
population without an increase in office telephone calls, postdischarge opioid prescriptions, and ED visits.
Oral Dexamethasone Following Pediatric
Adenotonsillectomy: A Randomized
Controlled Trial
Ariana Ghom Greenwell (Presenter); Amal Isaiah, MD, PhD;
Judy Oakley, MSN, MPH; Kevin D. Pereira, MD, MS(ORL)
Objectives: Adenotonsillectomy (AT) is one of the most
common pediatric surgeries performed in the United States.
Currently, there is lack of consensus regarding optimal postoperative pain management. Retrospective data suggest that corticosteroids can help with pain control following AT. However,
there is no high-quality evidence to support their routine use.
Methods: A prospective randomized trial in children aged 3
to 10 years with sleep-disordered breathing undergoing AT a
tertiary care center between July 2017 and December 2019 was
performed. Children received either standard analgesia (alternating weight-based dosing of ibuprofen and acetaminophen)
or dexamethasone (0.6 mg/kg) administered on postoperative

Pediatric

testing results. Studies were approved by respective internal
review boards, guardian informed consent was obtained, and
blood or saliva samples were collected. All identified genetic
hearing loss subjects were counseled, referred for further
testing, and offered hearing aids when appropriate.
Results: In Beijing, we found that 10 of 40 (25%) infants
who passed had 1 of the 2 major pathogenic variants (GJB2 or
SLC26A4). In addition, we found that 405 of 409 (99%)
infants with m.155A>G or m.1494C>T variants passed the
NBHS. In Miami, we found that, of the infants tested with current hearing loss who passed NBHS, 62% had a genetic
mutation.
Conclusions: Our studies show that despite the increasing
diversity of NBHS, up to 25% of infants with genetic etiologies of hearing loss can be missed. This review highlights the
importance of genetic testing in conjunction with the NBHS.

P127

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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