Provider education decreases opioid prescribing after pediatric umbilical hernia repair

J Pediatr Surg. 2020 Jul;55(7):1319-1323. doi: 10.1016/j.jpedsurg.2019.04.035. Epub 2019 May 11.


Purpose: To improve opioid stewardship for umbilical hernia repair in children.

Methods: An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared.

Results: A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001) post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18-0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts.

Conclusions: Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention.

Type of study: Retrospective cohort study.

Level of evidence: Level II.

Keywords: Opioid stewardship; Opioids; Pain control; Pediatrics; Provider education; Umbilical hernia repair.

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Drug Prescriptions / statistics & numerical data*
  • Hernia, Umbilical / surgery*
  • Herniorrhaphy
  • Humans
  • Pain, Postoperative / drug therapy
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Retrospective Studies
  • Surgeons / education*


  • Analgesics, Opioid