Evaluating Postoperative Opioid Prescription Fills and Refills for Adolescents Undergoing Surgery

Introduction

Prescription drug monitoring programs (PDMPs) are state-run databases that track controlled substances to reduce substance use and diversion. The accuracy of PDMPs for adolescents who receive postoperative opioid prescriptions is unknown.

Methods

This prospective cohort study was conducted at a free-standing tertiary children’s hospital from 2019 to 2020. Adolescents 13-20 y undergoing elective surgery commonly associated with an opioid prescription at discharge were enrolled. Prescription opioid fills and refills were measured through five data sources: (1) Electronic Medical Record (EMR) prescription orders (2) postoperative clinic notes, (3) California’s PDMP and (4) adolescent and (5) parent surveys. UpSet plots were used to visualize and quantify data overlap between sources.

Results

The majority of the 55 adolescents enrolled were Hispanic/Latino (52.7%), female (54.5%), and underwent posterior spinal fusion (41.8%). Of 42 adolescents with an opioid prescription in the EMR, the greatest overlap in data sources occurred between the EMR and PDMP (92.9%) with only 19% of adolescents having their opioid prescription fill captured in all five data sources. Two patients (3.6%) who did not receive an opioid prescription based on EMR or survey data were identified in the PDMP. Survey data indicated that eight adolescents (19.0%) refilled their opioid prescription. However, the PDMP only captured four (9.5%) refills.

Conclusion

Discrepancies exist among EMR, PDMP, and survey documentation of prescription opioid dispensing and refills for adolescents undergoing surgery. These findings highlight the need to capture multiple data sources when tracking prescription opioid dispensing. Additionally, there is opportunity for improved accuracy within prescription drug monitoring programs.

Type of Study

Prospective Cohort Study.

Level of Evidence

Level 4.