Comparing Provider and Adolescent Estimates of Postoperative Opioid Use.

Comparing Provider and Adolescent Estimates of Postoperative Opioid Use - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice J Surg Res . Author manuscript; available in PMC: 2026 Jun 1. Published in final edited form as: J Surg Res. 2025 Apr 25;310:137–144. doi: 10.1016/j.jss.2025.03.057 Comparing Provider and Adolescent Estimates of Postoperative Opioid Use Emma Kirkpatrick a , Olivia A Keane b , Shadassa Ourshalimian b , Madeleine Ing a , Marjorie Odegard b , Eugene Kim c , Lorraine I Kelley-Quon a, b, d Author information Article notes Copyright and License information a Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA b Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA c Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA d Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA ✉ Corresponding Author: Emma Kirkpatrick, BS, MD Student Class of 2026, Keck School of Medicine of USC, Children’s Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd. MS #100, Los Angeles CA 90027, ekirkpat@usc.edu Author Contributions Authors MI, MO, and LK were involved in study conception and design. EK a conducted data collection. SO, EK, a and LK were involved in data analysis and interpretation of results. EK, a OK, and LK drafted the initial manuscript. EK, a OK, SO, MO, MI, EK, b and LK contributed revisions to the manuscript and approved the submitted version of the manuscript. a Emma Kirkpatrick b Eugene Kim Issue date 2025 Jun. PMC Copyright notice PMCID: PMC12162198  NIHMSID: NIHMS2072507  PMID: 40286576 The publisher's version of this article is available at J Surg Res Abstract Background: Most adolescents report unused opioids after surgery. Current interventions compare opioid prescribing between surgeons without capturing actual patient-reported use. Methods: We recruited pediatric surgery residents, fellows, advanced practitioners, and surgeons from four surgical divisions at a tertiary care children’s hospital. Providers reviewed clinical vignettes based on adolescent-reported postoperative opioid use data from our institution. Afterwards, providers were asked to select the number of opioid pills they would prescribe and compare their responses to adolescent-reported use. We then measured provider willingness to change prescribing practices based on this comparison. Results: Overall provider response rate was 41.3%(N=38/92). Providers underestimated the number of opioids used for posterior spinal fusion, open pectus excavatum repair, open pectus carinatum repair, knee arthroscopy, and tonsillectomy and overestimated opioid use following hip reconstruction. Differences in median postoperative opioid use estimates from providers versus adolescent-reported use were significant for knee arthroscopy(10 IQR[0-3] vs. 3 IQR[1.5-13];p<0.001) and tonsillectomy(0 IQR[0-2.5] vs. 1 IQR[0-7];p=0.043). Overall, general pediatric surgery providers underestimated opioid use while orthopedic and cardiothoracic providers overestimated opioid use. Differences between provider specialty were significant for posterior spinal fusion(p=0.022), knee arthroscopy(p<0.001), and tonsillectomy(p=0.005). The number of opioids prescribed varied by provider role and 88.9% of providers(N=32/36) reported that they would change prescribing habits based on adolescent reports. Conclusion: There are differences in provider estimates of postoperative prescription opioid use versus adolescent-reported use. Fortunately, providers report a willingness to change prescribing practice based on these differences. Feedback incorporating patient-reported postoperative opioid use may be a more accurate and patient-centered way to decrease excess opioid prescribing. Keywords: adolescent, pediatric, postoperative, opioid, pediatric surgery, patient feedback, prescription opioid Introduction Despite a decline in adolescent prescription opioid misuse over the past 20 years, 1 adolescents remain at risk as they continue to receive new opioid prescriptions. 2 This risk is concerning due to the association of prescription opioid use with later misuse and increased risk of future substance use and risk-taking behavior. 3 - 7 An estimated 19% of adolescents have used prescription opioids within the past year 8 and the incidence of adolescent prescription opioid overdose has doubled since the late 1990s. 9 Notably, the majority of opioid prescriptions for children and adolescents are prescribed by surgeons and dentists 10 and many pediatric patients and their caregivers report leftover prescription opioids after surgery, which may indirectly contribute to future prescription opioid misuse and diversion. 11 - 15 This discrepancy underscores an area for potential improvement and highlights the need to examine perioperative prescribing habits. Prior literature has established the tendency for providers to overprescribe opioids after surgery and emphasized that postoperative opioid prescribing interventions are necessary. 16 Previous research has also demonstrated that providers are inclined to change their own prescribing practices when notified of outcomes 17 or compared to their peers. 18 While comparisons between providers are valuable, interventions that prioritize patient-centered feedback may be more informative to guide opioid prescribing. There is no prior research in pediatric surgery describing the willingness of providers to change their postoperative prescribing practices after they are presented with feedback from their patients. This study seeks to identify differences in provider-reported opioid prescribing versus real-world adolescent-reported postoperative opioid use. Additionally, we aimed to identify differences in opioid prescribing across specialties and provider roles. Finally, we evaluated provider willingness to change prescribing habits when presented with adolescent-reported opioid use. We hypothesized that providers would be willing to change their prescribing habits after reviewing postoperative use data provided by adolescents undergoing surgery at their hospital. Methods Study Design A cross-sectional study was performed using a survey to assess provider opioid prescribing habits and opinions, patient education practices, and willingness to change postoperative opioid-prescribing practices when provided with postoperative opioid use data reported by adolescents. The adolescent-reported data was extracted from a previous survey study completed at our instititution. 11 , 19 This study was performed at a tertiary children’s hospital and regional referral center. This study was approved by Children’s Hospital Los Angeles (CHLA) Institutional Review Board. Given the anonymous nature of the study, an approved waiver of informed consent was obtained from the IRB. Providers were informed prior to their participation in the study that their data would remain anonymous and confidential. Participants Surgeons, fellows, residents, and advanced practice providers (including nurse practitioners and physician assistants) from pediatric general surgery, orthopedic surgery, cardiothoracic surgery, and otolaryngology specialties at CHLA were recruited to complete the survey via email invitation through REDCap. 20 Providers were contacted with an initial email invitation before being sent up to 3 reminder emails from July to October 2023. Survey Design The survey was created and administered through REDCap. It was pretested by six surgeons to evaluate the language and usability. The survey instrument included six different clinical vignettes describing a typical adolescent undergoing a surgery commonly associated with a postoperative opioid prescription (e.g. “A 14-year-old girl who has undergone posterior spinal fusion is deemed appropriate for discharge on POD 3.”; Supplement 1 ). The surgeries included were posterior spinal fusion, open pectus excavatum repair, open pectus carinatum repair, hip reconstruction for juvenile idiopathic arthritis, knee arthroscopy for meniscal tear, and outpatient tonsillectomy. These surgeries were selected because they are commonly performed and associated with an opioid prescription at discharge at our institution. Given that these clinical vignettes encompass various surgical specialties, the survey acknowledged that providers might encounter questions outside the scope of their field of surgical practice and requested that each provider, “answer to the best of your clinical abilities and with your general understanding of the procedure highlighted in each question”. For each clinical vignette, the provider was asked to report the dose in milligrams and number of oxycodone pills that they would prescribe. At the completion of each vignette, providers were shown a table comparing the number of opioid pills they prescribed for each case compared to adolescent-reported opioid use data for the same procedure at our institution. Adolescent-reported opioid use data was extracted from a previous prospective study of 119 adolescents who underwent surgery at CHLA from 2019-2020. 11 , 19 The survey instrument for the present study reported the cumulative median and interquartile range opioid pill use for each relevant vignette. Providers were then presented with the number of leftover pills (e.g. “This would leave your patient with 5 leftover pills”) or number of pills under prescribed (e.g. “This would leave your patient with −3 leftover pills”) for each patient ( Supplement 2 ). After reviewing the number of excess or insufficient prescribed pills for each clinical vignette, the providers were asked to indicate whether they would change their opioid prescribing practices in the future based on this new information. At the end of the survey, providers were asked about their overall prescribing practices for adolescents undergoing surgery. Analysis All data was collected, deidentified, and managed through REDCap. Categorical variables were reported using frequencies and percentages. Continuous variables were reported using median and interquartile range for skewed data. The recommended dosage and number of oxycodone pills reported by providers were converted to a standard equivalent dose for comparison. In this study, each opioid pill is standardized to 5 mg of oxycodone. Differences in provider recommended opioid prescription versus real-world adolescent-reported use were analyzed using Wilcoxon-Mann Whitney tests. Differences in recommended number of opioid pills across surgical specialties and provider roles were assessed using Kruskal-Wallis tests. A p-value <0.05 was used to determine statistical significance. For any category within surgical specialty or provider role that received 0-1 responses, the category was excluded from the statistical analysis. Data were analyzed using SAS ® software 9.4 (copyright © 2016 SAS Institute Inc., Cary, NC). Results Provider demographics Overall, 38 providers at CHLA participated in our study with a response rate of 41.3%, which comprised of 27 (71.1%) from general pediatric surgery, 6 (15.8%) from orthopedic surgery, 4 (10.5%) from cardiothoracic surgery, and 1 (2.63%) from otolaryngology. This included 14 (36.8%) attendings, 11 (28.9%) fellows/residents, and 13 (34.2%) advanced practice providers (APPs) ( Table 1 ). Table 1. Provider characteristics. N % Total Providers 38 - Provider Specialty General Pediatric Surgery 27 71.1 Orthopedic Surgery 6 15.8 Cardiothoracic Surgery 4 10.5 Otolaryngology 1 2.63 Provider Role Attending 14 36.8 Fellow/Resident 11 28.9 APP * 13 34.2 Open in a new tab * APP = advanced practice provider (nurse practitioner or physician assistant) Comparison of provider prescribing versus real-world adolescent opioid use The median number of postoperative opioid pills estimated by providers was less than the median adolescent-reported number of opioid pills used for the following clinical vignettes: posterior spinal fusion (6.5 IQR [4-12] vs 10 IQR[5-20], p = 0.092), open pectus excavatum repair (5.5 IQR[2.5-12] vs 8 IQR[4-10], p = 0.704), open pectus carinatum repair (7.25 IQR[3-12] vs 10 IQR[10-10], p = 0.720), knee arthroscopy (0 IQR[0-3] vs 3 IQR[1.5-13], p < 0.001), and tonsillectomy (0 IQR[0-2.5] vs 1 IQR[0-7], p = 0.043; Table 2 ). In contrast, the median number of opioid pills recommended by providers for hip reconstruction was greater than median adolescent-reported use (10 IQR[5-15] vs 6.5 IQR[4.5-11.5], p = 0.676). These differences were significant for knee arthroscopy (p < 0.001) and tonsillectomy (p = 0.043). Table 2: Number of prescription opioid pills * recommended by providers compared to number of prescription opioid pills used by adolescents. † Survey Provider recommended Adolescent - reported Difference of medians P-value Procedures Median IQR Median IQR Posterior spinal fusion 6.5 4-12 10 5-20 −3.5 0.092 Open pectus excavatum repair 5.5 2.5-12 8 4-10 −2.5 0.704 Open pectus carinatum repair 7.25 3-12 10 10-10 −2.75 0.720 Hip reconstruction 10 5-15 6.5 4.5-11.5 +3.5 0.676 Knee Arthroscopy 0 0-3 3 1.5-13 −3 <.001 Tonsillectomy 0 0-2.5 1 0-7 −1 0.043 Open in a new tab * 1 opioid pill = 5 mg oxycodone † The adolescent-reported data was extracted from a pilot study conducted by our group at CHLA 11 , 19 Comparison of opioid prescribing between provider specialties General pediatric surgery providers recommended a median number of opioid pills less than the median adolescent-reported number for all clinical vignettes: posterior spinal fusion (5 IQR[0-10] vs 10 IQR [5-20]), open pectus excavatum repair (5 IQR[2.5-12] vs 8 IQR[4-10]), open pectus carinatum repair (6 IQR[2.5-12] vs 10 IQR[10-10]), hip reconstruction (6 IQR[5-15] vs 6.5 IQR[4.5-11.5]), knee arthroscopy (0 IQR[0-0] vs 3 IQR[1.5-13]), and tonsillectomy (0 IQR[0-0] vs 1 IQR[0-7]; Table 3 ). In contrast, providers from orthopedic and cardiothoracic surgery recommended a median number of opioid pills greater than adolescents reported taking for all clinical vignettes: posterior spinal fusion (22.5 IQR[10-30] vs 12.5 IQR[7-15] vs 10 IQR[5-20]), open pectus excavatum repair (15 IQR[3-20] vs 11 IQR[7.5-13.5] vs 8 IQR[4-10]), open pectus carinatum repair (15 IQR[3-20] vs 11 IQR[7.5-13.5] vs 10 IQR[10-10]), hip reconstruction (20 IQR[10-25] vs 10 IQR[10-11] vs 6.5 IQR[4.5-11.5]), knee arthroscopy (4.5[0-10] vs 6.5[2.8-15] vs 3[1.5-13]), and tonsillectomy (2[0-10] vs 3.75[1.25-7.5] vs 1[0-7]). Table 3: Comparison of the number of opioid pills * recommended for each procedure by provider specialties. General Pediatric Surgery Orthopedic Surgery Cardiothoracic Surgery Procedures N Med IQR Diff † N Med IQR Diff † N Med IQR Diff † P-Value Posterior spinal fusion 27 5 0-10 −5 6 22.5 10-30 +12.5 4 12.5 7-15 +2.5 0.022 Open pectus excavatum repair 27 5 2.5-12 −3 6 15 3-20 +7 4 11 7.5-13.5 +3 0.178 Open pectus carinatum repair 27 6 2.5-12 −4 6 15 3-20 +5 4 11 7.5-13.5 +1 0.269 Hip reconstruction 26 6 5-15 −0.5 6 20 10-25 +13.5 4 10 10-11 +3.5 0.119 Knee Arthroscopy 26 0 0-0 −3 6 4.5 0-10 +1.5 4 6.5 2.8-15 +3.5 <.001 Tonsillectomy 26 0 0-0 −1 6 2 0-10 +1 4 3.75 1.25-7.5 +2.75 0.005 Open in a new tab * 1 opioid pill = 5mg of oxycodone † Diff = difference of medians between survey provider recommended number of opioid pills and adolescent-reported number of opioid pills used The single provider from otolaryngology recommended 0 opioid pills for the following clinical vignettes: posterior spinal fusion, open pectus excavatum repair, open pectus carinatum repair, hip reconstruction, and knee arthroscopy. However, the otolaryngology provider recommended 20 opioid pills for tonsillectomy, while the adolescents reported using a median of 1 opioid pills (IQR 0-7) postoperatively. Overall, differences in the number of opioids recommended between provider specialty (pediatric general surgery, orthopedic surgery, and cardiothoracic surgery) were significant for posterior spinal fusion (p=0.022), knee arthroscopy (p<0.001), and tonsillectomy (p=0.005). The provider from otolaryngology was excluded from this statistical analysis due to the sample size of 1. Comparison of opioid prescribing between provider roles Attending providers recommended a similar median number of opioid pills compared to the adolescent-reported median for posterior spinal fusion (10 IQR[0-20] vs 10 IQR[5-20]), open pectus excavatum repair (7.5 IQR[0-20] vs 8 IQR[4-10]), and open pectus carinatum repair (10 IQR[0-15] vs 10 IQR[10-10]; Table 4 ). Attending providers recommended a median number of opioid pills that was less than the median reported by adolescents for knee arthroscopy (0 IQR[0-4] vs 3 IQR[1.5-13]), and tonsillectomy (0 IQR[0-4] vs 1 IQR[0-7]). However, attending providers recommended a median number of opioid pills greater than the adolescent-reported median for hip reconstruction (10 IQR[5-20] vs 6.5 IQR[4.5-11.5]). Table 4: Comparison of the number of opioid pills recommended for each procedure by provider roles. Attending Fellow/Resident APP * Procedures N Med IQR Diff † N Med IQR Diff † N Med IQR Diff † P-Value Posterior spinal fusion 14 10 0-20 0 11 5 4-10 −5 13 7 5-12 −3 0.418 Open pectus excavatum repair 14 7.5 0-20 −0.5 11 2.5 0-4 −5.5 13 10 6-12 +2 0.018 Open pectus carinatum repair 14 10 0-15 0 11 4 0-8 −6 13 10 6-15 0 0.076 Hip reconstruction 13 10 5-20 +3.5 11 5 2.5-10 −1.5 13 10 7-15 +3.5 0.224 Knee Arthroscopy 13 0 0-4 −3 11 0 0-0 −3 13 0 0-3 −3 0.175 Tonsillectomy 13 0 0-4 −1 11 0 0-2.5 −1 13 0 0-0 −1 0.772 Open in a new tab * APP = advanced practice provider (nurse practitioner or physician assistant) † Diff = difference of medians between provider recommended number of opioid pills and adolescent-reported number of opioid pills used. Fellow and resident providers recommended a median number of opioid pills less than the adolescent-reported median across all clinical vignettes: posterior spinal fusion (5 IQR[4-10] vs 10 IQR[5-20]), open pectus excavatum repair (2.5 IQR[0-4] vs 8 IQR[4-10]), open pectus carinatum repair (4 IQR[0-8] vs 10 IQR[10-10]), hip reconstruction (5 IQR[2.5-10] vs 6.5 IQR[4.5-11.5]), knee arthroscopy (0 IQR[0-0] vs 3 IQR[1.5-13]), and tonsillectomy (0 IQR[0-2.5] vs 1 IQR[0-7]). Advanced practice providers recommended a similar median number of opioid pills compared to the adolescent-reported median for open pectus carinatum repair (10 IQR[6-15] vs 10 IQR[10-10]). APPs recommended a greater median number of opioid pills than the adolescent-reported median for open pectus excavatum repair (10 IQR[6-12] vs 8 IQR[4-10]) and hip reconstruction (10 IQR[7-15] vs 6.5 IQR[4.5-11.5]). APPs recommended a median number of opioid pills less than the median reported by adolescents for posterior spinal fusion (7 IQR[5-12] vs 10 IQR[5-20]), knee arthroscopy (0 IQR[0-3] vs 3 IQR[1.5-13]), and tonsillectomy (0 IQR[0-0] vs 1 IQR[0-7]). Overall, differences in the number of opioids recommended between provider roles (attending, fellow/resident, and APP) were significant only for open pectus excavatum repair (p=0.018). Provider willingness to change prescribing practice There were 36 (94.7%) providers who completed the questions regarding likelihood of changing future prescribing practices. The majority indicated they would likely change their prescribing habits based on the information provided within the survey for the following surgical cases: posterior spinal fusion (52.8%), open pectus excavatum repair (63.9%), open pectus carinatum repair (55.6%), and hip reconstruction (66.7%). In contrast, the minority of providers indicated willingness to change their prescribing habits for knee arthroscopy (47.2%) and tonsillectomy (33.3%). Overall, 88.9% of providers (N=32/36) reported that they would change prescribing habits for at least one of the surgical cases based on the adolescent-reported opioid use data. Of the providers who indicated they would change their future prescribing practices based on adolescent-reported opioid use, the majority selected a congruent direction for this change for all clinical vignettes: posterior spinal fusion (89.5%), open pectus excavatum repair (87.0%), open pectus carinatum repair (90.0%), hip reconstruction (95.8%), knee arthroscopy (88.2%), and tonsillectomy (66.7%). A congruent direction represents that providers who overestimated adolescent postoperative opioid use indicated they would prescribe fewer opioids in the future. In contrast, providers who underestimated adolescent postoperative opioid use indicated they would prescribe more opioids postoperatively for that specific surgery in the future. Factors that affect excess and inadequate opioid prescribing There were 35 (92.1%) providers who completed the questions regarding factors that affect opioid prescribing. Assessing factors affecting excess opioid prescribing, 65.7% of survey providers indicated patient/family fear of inadequate pain control and 60% indicated prescriber fear of inadequate pain control ( Table 5 ). Other factors indicated were prescribing patterns learned from medical training (48.6%) and patient/family requesting more opioids (45.7%). Conversely, for factors influencing inadequate opioid prescribing, 68.6% of providers selected patient/family fear of addiction and 65.7% selected prescriber fear of addiction. Table 5. Provider opinions on factors contributing to excess and inadequate opioid prescribing. Providers Factors contributing to excess opioid prescribing N % Patient/family fear of inadequate pain control 23 65.7 Prescriber fear of inadequate pain control 21 60.0 Prescribing patterns learned from medical training 17 48.6 Patient/family requesting more opioids 16 45.7 Limited time during patient encounters 8 22.9 Pharmaceutical industry marketing 1 2.89 None of the above 0 0 Factors contributing to inadequate opioid prescribing Patient/family fear of addiction 24 68.6 Prescriber fear of addiction 23 65.7 Extra steps required to query prescription drug monitoring 10 28.6 Excess documentation required 5 14.3 None of the above 3 8.57 Open in a new tab Provider education habits regarding opioid prescribing There were 35 providers who completed the questions regarding education habits. When asked whether they educate patients/families about safe opioid use, 80% of providers selected yes. However, when asked if they educate patients/families about safe opioid storage and disposal, only 28.6% of providers selected yes. Furthermore, only 31.4% of providers indicated that they know where the secure opioid disposal bin is located within the hospital. Discussion This survey study investigating opioid prescribing habits for adolescents undergoing surgery found significant differences in provider estimates of postoperative opioid use versus adolescent-reported actual opioid use. Provider recommendations generally underestimated the number of opioids used by adolescents, but this was largely dependent on provider specialty and role. However, most providers indicated that they would change their prescribing practices based on the real-world opioid use data reported by adolescent patients. To our knowledge, this study is the first to investigate provider response to patient-reported use of postoperative opioids in the pediatric population. These findings are particularly relevant as more hospitals are relying on peer comparisons of opioid prescribing rather than patient informed feedback. 12 , 21 - 26 Interventions leveraging patient-reported opioid use data may be necessary to augment current opioid stewardship efforts. Overall, with the exception of adolescents undergoing hip reconstruction, providers underestimated postoperative opioid use compared to adolescent-reported actual postoperative opioid use for most surgeries. This was surprising as previous research shows that providers on average overprescribe opioids postoperatively. 13 , 21 Future studies should examine outcomes of underprescribing opioids postoperatively including pain, additional healthcare visits, and medication refill requests. Specialty specific variations were noted with general pediatric surgery providers tending to underestimate and orthopedic and cardiothoracic surgery providers tending to overestimate adolescent-reported opioid use across all clinical vignettes. It is important to note that most of our survey respondents were from general surgery (71.1%), but many of the clinical vignettes referenced orthopedic and otolaryngology surgeries. The tendency for general pediatric surgery respondents to underestimate the number of opioids used postoperatively could be due to the increased push for opioid stewardship and judicious prescribing practices within general pediatric surgery specifically. 16 , 21 , 22 , 27 This coupled with a possible lack of experience with postoperative pain management for orthopedic and otolaryngology procedures may explain our findings. Conversely, orthopedic and cardiothoracic providers in our study overestimated opioid needs consistent with previous literature. 23 , 28 - 31 Future efforts to optimize opioid stewardship for surgical specialities therefore must engage both surgeon specialist expertise and real world patient data. There were also notable variations in prescribing habits across provider roles. Fellows and residents tended to underestimate the adolescent-reported number of opioids used across all the clinical vignettes, while attendings and APPs more closely approximated the adolescent-reported number of opioids used for posterior spinal fusion, open pectus excavatum repair, and open pectus carinatum repair. These findings may indicate an increased effort to encourage judicious opioid prescribing in current medical training, but also underscores the value of clinical experience. Indeed, our findings are consistent with previous research reporting that attending surgeons are more confident in managing postoperative pain and less fearful of addiction compared to their trainees. 32 Attendings also report relying heavily on personal experience and informal training from colleagues to guide opioid prescribing decisions. 23 As such, we need to provide residents with early standardized guidelines to inform their opioid prescribing decisions. Overall, the vast majority of providers regardless of training level were willing to change prescribing practices based on patient use data. Future interventions designed to optimize opioid prescribing should utilize patient-centered data. Additionally, our results show that providers try to balance fear of inadequate pain control against fear of future addiction when deciding to prescribe opioids. While most providers in this study reported educating patients and their families on safe opioid use, less than a third reported educating on safe opioid storage and disposal. Previously our institution found that only 22% of adolescents and their parents reported safe opioid disposal. 11 Viewed alongside the current study’s results, this lack of safe opioid disposal by families is likely due to lack of provider instructions. Most patients and their families are not aware of the risks of leftover opioids in the home or how to properly dispose of them. 33 However, those that do receive education on safe opioid disposal are more likely to properly dispose rather than retain leftover opioids. 34 Our findings emphasize the need for providers to educate patients and families on safe prescription opioid storage and disposal to prevent high risk behavior for adolescents and other members of their household. Finally, current efforts to expand principles of opioid stewardship to providers have largely been limited to hospital level or provider-provider comparisons emphasizing the wide variability in practice. 12 , 21 - 25 However, interhospital or peer comparisons do not capture patient-reported opioid use or patient satisfaction with pain control. While lateral comparisons do minimize hospital and provider level variation, if a group of hospitals or providers are over or underprescribing, these efforts may not meet actual patient needs. Interventions guided by patient-reported opioid use have been previously trialed in adults, which reduced postoperative opioid prescriptions by 23-78%. 35 , 36 To our knowledge, the current study is the first to describe a similar intervention in a pediatric population. Our study underscores the need for actual patient-reported use of postoperative opioids to be tracked and fed back to providers to balance opioid prescribing with actual patient use. Limitations This study was limited to providers practicing at a single tertiary care children’s hospital located in a large metropolitan area. As such, our results may not be widely generalizable across specialties, institutions, and geographical regions. Additionally, the sample size limited our ability to evaluate statistically significant differences between subgroups of surgical specialties and provider types. Future research should utilize a multicenter study or larger sample across different hospital settings to enhance generalizability. Further, a larger cohort of adolescents enhancing the patient-reported data would allow for analysis of patient-specific factors such as anesthesia protocols or adjuct analgesic use. Our response rate of 41% is comparable to previous published studies with response rates ranging from 15-50%. 37 - 41 However, our study results may still be limited by response bias as providers who responded to this survey study might be more judicious opioid prescribers than the non-responders. Future studies should employ strategies to increase participation such as incentives or mandatory survey distribution within provider meetings to mitigate this bias. We also did not utilize provider prescription records, but instead relied upon provider self-reported opioid prescribing recommendations which may not reflect actual prescribing habits. Furthermore, adolescents may not have accurately remembered their opioid consumption. Thus, recall bias may affect the reliability of the adolescent-reported opioid use data. Future studies and interventions relying on patient-reported opioid use should consider incorporating electronic medication monitoring 42 or parental reports to cross-check self-reported use. Lastly, while most providers reported willingness to change prescribing practice, a future study would be necessary to evaluate the actual changes in postoperative opioid prescribing after participation in this study. Conclusions The findings of the study highlight differences in provider estimates of postoperative opioid use versus adolescent-reported postoperative opioid use, with variation in prescribing practices across specialties and provider roles. Fortunately, providers report a willingness to change prescribing habits in the appropriate direction when presented with real-world opioid use data from actual adolescent patients. This underscores the need for postoperative opioid prescribing interventions that leverage data from real-world patient-reported opioid use. Supplementary Material 1 Supplement 1: Clinical vignette descriptions used in the survey instrument. NIHMS2072507-supplement-1.docx (13.8KB, docx) 2 Supplement 2: Example of adolescent-reported opioid use data used in the survey instrument. NIHMS2072507-supplement-2.docx (125KB, docx) Funding This work was supported by grant KL2TR001854 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. This work was also supported by team science grant UL1TR001855 from the Southern California Clinical and Translational Science Institute and by the University of Southern California Institute for Addiction Science institutional pilot grant funding program. The funding sources did not have a role in data collection, interpretation, or analysis, the writing of this manuscript, or the decision to submit for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources. Footnotes Study Type Cross-sectional survey study Level of Evidence III Disclosure The authors have no conflicts of interest to disclose. Availability of Data Survey respondents were assured prior to participation in the study that their raw data would remain confidential and none of their information would be disclosed. Thus, the data from this study is unavailable. Meeting Presentation Presented at the AAS/SUS Academic Surgical Congress on February 13 th , 2025. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. 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Supplementary Materials 1 Supplement 1: Clinical vignette descriptions used in the survey instrument. NIHMS2072507-supplement-1.docx (13.8KB, docx) 2 Supplement 2: Example of adolescent-reported opioid use data used in the survey instrument. NIHMS2072507-supplement-2.docx (125KB, docx) ACTIONS View on publisher site PDF (121.7 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

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