Pediatric Post-Tonsillectomy Opioid Prescribing Practices

Yusuf M. Agamawi, Lauren M. Cass, Maggie Mouzourakis, Jaibir S. Pannu, Jennifer V. Brinkmeier

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: To evaluate the effect of discharge order sets on prescribing patterns of opioids after pediatric tonsillectomy. Secondary outcomes included encounters for postoperative pain, dehydration, and bleeding. Methods: Retrospective chart review of pre- and post-intervention in pediatric post-tonsillectomy patients, 0–18 years old (n = 1486). Order sets were installed with age-specific analgesic medication defaults and recommendation of concurrent alternating scheduled ibuprofen and acetaminophen. Time-balanced pre- and post-intervention cohorts were established. Opioid outcomes calculated in morphine milligram equivalents per kilogram (MME/kg) per dosage and total prescribed. Results: Discharge order set intervention resulted in 17% reduction of opioid dose prescribed (0.095 MME/kg [95% CI, 0.092–0.099] vs. 0.079 [95% CI, 0.076–0.083], P <.001). Total number of opioid doses prescribed was reduced after order set implementation (46.4 [95% CI, 43.6–49.1] to 20.3 [95% CI, 19.1–21.5], P <.001). Patients <7 years old prescribed opioids remained rare in pre- and post-intervention groups (1.6% and 1.8%, respectively, P =.86). Admissions and emergency department visits for postoperative dehydration and pain were significantly reduced. Post-intervention group showed an increase in readmissions for post-tonsillectomy hemorrhage (9.2% vs. 5.2%, P =.003) which was isolated to an increase in the older post-intervention group after stratification by age. Conclusion: Utilization of order sets with standardized analgesic medication regimen of acetaminophen, ibuprofen, and opioid helped effectively reduce opioid amount per dose, total opioid amount dispensed, and variability in the total opioid amount dispensed while maintaining pain control. An increase in post-tonsillectomy hemorrhage was recognized following this implementation which did not persist after the study period despite continuation of intervention. Level of Evidence: 4 Laryngoscope, 131:1386–1391, 2021.

Original languageEnglish
Pages (from-to)1386-1391
Number of pages6
Issue number6
StatePublished - Jun 2021


  • electronic medical record (EMR)
  • opioids
  • order sets
  • Pediatric
  • tonsillectomy


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