Reducing Opioid Prescriptions for Common Pediatric Urologic Procedures

Reducing Opioid Prescriptions for Common Pediatric Urologic Procedures 1024 682 JoAnna Pendergrass, DVM
smiling baby being held up by an adult

To address the national opioid epidemic, clinician-scientists developed a quality improvement initiative to achieve significant, long-term reductions in opioid prescriptions after common pediatric urologic procedures.


Opioids are commonly prescribed for pediatric urologic procedures. However, studies have reported a troubling practice of overprescribing opioids in pediatric health, contributing to the ongoing opioid epidemic.

“There is a common misperception that all children undergoing urologic surgery need opioids,” says Seth Alpert, MD, a pediatric urologist at Nationwide Children’s Hospital.

In 2018, the American Academy of Pediatrics (AAP) issued a 6-month challenge for pediatric surgeons to reduce opioid prescriptions at discharge to less than 50% of baseline values for commonly performed procedures.

The hospital’s pediatric urology providers responded to the challenge in July 2018. Dr. Alpert and his team developed a quality improvement (QI) initiative to implement this challenge in a single-center study at Nationwide Children’s. Their study, published in Pediatric Quality and Safety, reported significant and sustained reductions in opioid prescriptions for three outpatient pediatric urologic procedures: circumcision, orchiopexy and inguinal hernia repair (IHR).

“This study showed that, for these outpatient procedures, most children do not need opioids for pain management,” says Dr. Alpert.

To measure success, the researchers tracked the percentage of patients prescribed opioids and the total number of opioid doses prescribed per patient for each procedure until the study’s end in December 2021.

Follow-up phone calls were made from February to October 2019 to assess patients’ health status, including the number of prescribed opioid doses and how many doses were taken for post-operative pain after surgery.

During the study, 1,518 orchiopexies, 1,505 circumcisions and 531 IHRs were performed.

The average number of opioid doses per prescription significantly decreased from baseline to the study’s end for each procedure: orchiopexy (11.1 to 5.6), circumcision (10.9 to 5.0) and IHR (11.9 to 5.5).

Similarly, the percentage of patients receiving opioid prescriptions significantly decreased from baseline to the study’s end for each procedure: orchiopexy (70% to 27%), circumcision (81% to 1%) and IHR (80% to 15%).

Follow-up phone call data revealed that 48% of patients prescribed opioids did not take any doses. One patient’s parent reported inadequate pain control with the initial opioid prescription and requested an additional prescription.

Dr. Alpert recommends that providers do not routinely prescribe opioids as a “knee-jerk” habit after common pediatric urologic procedures. Instead, he advocates for prescribing OTC pain relievers, such as alternating doses of ibuprofen and acetaminophen.

“We educate the surgical residents that pediatric patients seemingly experience pain differently than adult patients and can often have their pain more than adequately controlled with OTC pain relivers without the need for opioid medications,” he explains.

Future studies include longitudinal data collection on opioid prescription practices at Nationwide Children’s and expanding this successful QI initiative to other institutions.

“Learning more about pain management will help us take better care of our young patients,” says Dr. Alpert. “We hope other institutions will try to emulate and implement this QI initiative into their practices to reduce opioid prescriptions for pediatric patients.”



Stout M, Alpert S, Kersey K, Ching C, DaJusta D, Fuchs M, McLeod D, Jayanthi R. Reducing opioid prescriptions after common outpatient pediatric urologic surgeries: a quality improvement assessment. Pediatric Quality and Safety. 2023 Jan 16;8(1):e623.


Image credit: Adobe Stock

About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.