Opioid Prescription Trends for Isolated Diaphyseal Femur Fractures in Pediatric Patients

Purpose: Despite the ongoing opioid epidemic, there is a lack of research on narcotic prescribing in the pediatric orthopaedic population. The Pediatric Orthopaedic Society of North America (POSNA) therefore published a survey on pain management to provide recommendations for opioid dosing. The goal of this study was to characterize opioid prescribing patterns for pediatric femur fractures in the context of the opioid epidemic and emerging national studies/guidelines. Methods: A retrospective review of 128 pediatric patients (age < 16) with isolated diaphyseal femur fractures was conducted between 2003-2019 at a level I pediatric trauma center. Comparison groups included before distribution of the POSNA survey (pre-POSNA = 01/01/2016 or earlier, N = 85) and after the survey (post-POSNA, N = 43). Results: Median total hospital post-operative opioids prescribed was 27.2 morphine milligram equivalents (MME). The two groups differed in: age (pre-POSNA = 9.0 years, post-POSNA =3.7 years, P =0.0381), hospital length of stay (LOS) (pre-POSNA = 2 days, post-POSNA =1 day, P < 0.0001), and procedural incision required for fracture reduction (pre-POSNA = 28.3%, post-POSNA = 58.1%, P = 0.0019). Adjusted post-operative opioid dosing was significantly lower post-POSNA (median reduction of 18.351 MME per year, P = 0.0408). Conclusions: The period following the POSNA survey was associated with a significant decline in post-operative narcotic prescriptions for pediatric femur fractures. The timing of the survey likely represents an increased concern for pediatric opioid use and a shift in clinical practice. Further work is needed to optimize injury and patient-specific narcotic prescribing.