National variation in opioid prescribing after pediatric umbilical hernia repair☆

Abstract

Background: Pediatric umbilical hernia repair is a common procedure that requires minimal tissue disruption. We examined variation in opioid prescription fills after repair of uncomplicated umbilical hernias to characterize the types and doses of medication used and persistent postsurgical use. Methods: Using the Truven Health Analytics MarketScan© Research Database for June 2012–September 2015, we identified pediatric patients undergoing umbilical hernia repair. We excluded patients with obstruction, gangrene, an earlier repair or a concurrent surgical procedure, and those without available pharmacy claim data. Analyses describe filled outpatient prescriptions by age, geographic region, drug type, quantity, and second prescriptions/refills. Results: Of 4,407 procedures performed, 2,292 patients (52%) filled a prescription for postoperative opioids (age 0–1 years: 21.6%, age 2–3 years: 51.5%, age 4–5 years: 54.3%, 6 years or older: 57.9% [P < .0001]). In the northeast United States, 42% of patients filled narcotic prescriptions, compared with 59% of patients in the south (P < .0001). Hydrocodone/acetaminophen was most commonly prescribed (51%), followed by codeine/acetaminophen (30%). Durations were ≤3 days (50%), 4–10 days (46%), and >10 days (4%). A total of 6% of patients filled a second opioid prescription within 30 days. Conclusion: Although many patients do not require opioids for umbilical hernia repair, most pediatric patients fill opioid prescriptions, including for prolonged courses and refills. Guidelines for appropriate prescribing of opioids after common, simple procedures, such as umbilical hernia repair, could improve the quality of care for children and impact the US epidemic of opioid abuse.