Do Children Need Opioids After Outpatient Urology Surgeries?
Paul Kokorowski, MD, MPH, shares what he’s learning from a four-year study at Children’s Hospital Los Angeles.
New results from a Children’s Hospital Los Angeles study show that many children undergoing outpatient urologic surgeries do not need postoperative narcotic medication.
The study, which is ongoing, is led by urologist Paul Kokorowski, MD, MPH, Director of Robotic Surgery at Children’s Hospital Los Angeles. Over the past four years, he and his team have collected data on opioid use—and recovery times—for more than 800 pediatric patients who underwent outpatient urologic surgeries at Children’s Hospital.
At the American Urological Association meeting in May, Dr. Kokorowski will present his findings related to opioid use and age. Here, he talks about what he’s learning overall—and the surprising reason why many parents give their child a postoperative dose of narcotic medication.
What is your goal for this study?
There hasn’t been much research into the factors that influence opioid use for this particular group: pediatric patients having outpatient urologic surgeries. We also wanted to have a better idea of how long it really takes pediatric patients to recover from these procedures.
If we can better understand both these patterns—opioid use and duration of recovery—then we can hopefully create protocols that will allow for good pain control but also minimize unnecessary distribution of narcotic medications.
What are you learning?
Our results show that children often don’t use much narcotic medication after these outpatient urologic surgeries. Many times, they are fine without any narcotic medication at all. That’s consistent with what has been found in other studies: We probably prescribe narcotics too much.
Are there certain children who use opioids more?
Older children—particularly adolescents ages 15 to 19—tend to use opioids more. They also tend to feel more pain and take longer to recover. One danger in this group is that adolescents often get adult-type doses, and any extra narcotic doses lying around the house can be abused. We also know that adolescents are one of the groups at risk for opioid addiction.
Why are you studying duration of morbidity? Don’t urologists already know how long it takes their patients to feel better?
We all have our own ideas about what recovery looks like for our patients, but we’re also subject to our own biases. Interestingly enough, it’s not necessarily a standard question that surgeons ask. At the postoperative visit, we will often ask, “How are things going? How are you feeling?” But it is not typical to ask, “How long was it before you didn’t have any pain? How many days did it take before your child was back to their normal self? How many days did your child actually take the opioid medication?”
So we started asking these questions and tracking the results for the purpose of taking a more systematic, structured look at this issue.
What are you learning about recovery times?
They vary widely. Certainly, younger children tend to get better quickly, and older children and teens take longer and have more pain. But even among children the same age, undergoing the same procedure, recovery times can be vastly different.
One of the things we’re studying now is how social and socioeconomic factors relate to duration of morbidity and opioid use. We’re trying to better understand which patients have such different experiences, so we can hopefully predict those patients who will have more trouble.
Did any of the study findings surprise you?
What I found interesting is that a lot of parents will give one dose of opioids the first night, thinking it will help their child sleep. And of course, it probably does. But I’m not sure that it’s a particularly appropriate use of opioid medication.
What is the key takeaway for urologists?
I think the enlightening part of this is, even when opioids are prescribed, many children don’t use them. And if they do, it’s often just that first evening when parents are worried about their child’s comfort—not as a response to pain.
Many pediatric urologists have already stopped prescribing opioids to most or all of their postoperative patients, but many others haven’t. I think this is more evidence showing that we need to move away from routinely prescribing these narcotics, particularly for younger patients.
See Paul Kokorowski, MD, MPH, at the American Urological Association annual meeting, May 15-18, 2020, in Washington, D.C. Dr. Kokorowski will be presenting results on “Post-Operative Opioid Use Following Ambulatory Pediatric Urological Procedures.”