Safety Assessment of Perioperative Pain Medications for Children (SAPPhire)

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PROJECT ABSTRACT Per capita opioid prescribing is higher in the US than in any other nation and the opioid crisis affects not only adults, but, also children and adolescents. Despite increases in pediatric hospitalizations related to opioid poisonings and opioid-related critical care unit admissions, yet, opioid use in children is understudied and underestimated. This gap in research is alarming given that drug use impairs child brain development and use of prescription opioids during childhood/early adolescence is a risk factor for prescription opioid misuse. One path to childhood opioid misuse begins with exposure after surgery for pain control and more than 2 million children undergo surgery in the US each year. Evidence also suggests that pediatric surgeons often prescribe more opioids than necessary following minor procedures with more than 50% of prescribed pills remaining unused, and resulting in excess opioids being stored in homes with children and, thus, becoming accessible for nonmedical use. Currently, no comprehensive data source exists that catalogues pediatric surgery perioperative pain management practices, including pain medication prescribing and that also assesses pain control, both of which are necessary to develop evidence-based recommendations for pediatric surgery perioperative pain management. This project, Safety Assessment of Perioperative Pain Medications for Children (SAPPhire),will create this unique data source to study, understand, and improve current pediatric surgery perioperative pain management, by combining data about current pain management practices (e.g., local anesthetics, regional nerve blocks, non-opioid analgesics, and pediatric-specific opioid prescribing practices), with patient-level demographic, health (e.g., comorbid conditions, surgical procedure), and outcomes (e.g., length of stay, surgical-site infections, and readmission) data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P). In addition, post-discharge opioid use and patient reported outcomes (PROs) on pain control and limitations of daily activities will be collected. Combined, these data will guide feedback and interventions to address surgeon- and hospital-level pain management practice variation and identify high “opioid-use” procedures and high “opioid-exposed” subgroups of pediatric surgical patients. The study will also assess adherence to FDA opioid medication contraindications and warnings. This formative study will provide essential information needed to develop pediatric procedure- and patient-specific guidelines for pain management. Lessons learned from SAPPhire will facilitate wider adoption of perioperative pain management practices across to the >150 NSQIP-P hospitals across the United States.