• Kaitlin N Piper, Katherine J Baxter, Martha Wetzel, Courtney McCracken, Curtis Travers, Bethany Slater, Sarah B Cairo, David H Rothstein, Robert Cina, Melvin Dassinger, Patrick Bonasso, Aaron Lipskar, Naomi-Liza Denning, Eunice Huang, Sohail R Shah, Megan E Cunningham, Raquel Gonzalez, Jeremy D Kauffman, Kurt F Heiss, Mehul V Raval, and Pediatric Surgical Research Collaborative - PedSRC.
• Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
• J. Pediatr. Surg. 2020 Jul 1; 55 (7): 1319-1323.

PurposeTo improve opioid stewardship for umbilical hernia repair in children.MethodsAn educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared.ResultsA total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001) post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18-0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts.ConclusionsOpioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention.Type Of StudyRetrospective cohort study.Level Of EvidenceLevel II.Copyright © 2019 Elsevier Inc. All rights reserved.

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