Assessment of current prevention and treatment strategies for pediatric opioid-associated constipation in a community hospital setting

Introduction: Pediatric patients may be at risk for complications of constipation when started on opioids without laxative medications. This study will assess the need for a standardized bowel management protocol for the pediatric population within a not-for-profit community health system. 

Objectives: To determine how often laxatives were prescribed with opioids in pediatric patients and compare the outcomes to patients without laxatives prescribed. Secondary objectives include assessing appropriateness of laxative dosing based on age and weight of patients and determining differences in prescribing patterns in the medical and surgical teams.

Study Design: This is a retrospective chart review of the use of opioids and laxatives in the pediatric population within a not-for-profit community health system.

Methods: Pediatric patients admitted from October 2011 to October 2015 were eligible for inclusion if they were between the ages of 2 and 17 years at the time of admission, were admitted for greater than or equal to 48 hours, and received greater than or equal to one dose of opioid pain medication. The target sample size is 50 patients. Exclusion criteria includes: cystic fibrosis, Hirschsprung disease, cerebral palsy, diabetes mellitus, celiac disease, impacted stool on admission, intestinal obstruction, lead poisoning, and hypothyroidism. Relevant data will be extracted from patient charts including patient’s age, weight, admission reason, dose/frequency of opioid and laxative, time to initiation of a bowel agent, time to stool, and past medical history. Data will be analyzed using Chi-squared, Fischer’s Exact, or Mantel-Haenszel test as appropriate.

Results: The average length of stay was 4.6 days in the 15 patients analyzed thus far. Of these patients, 27% were prescribed a laxative and 73% were not. Without laxatives, 40% of patients had a bowel movement prior to discharge. No stools were documented in the patients with laxatives ordered. The surgical team ordered 75% of all laxatives.

Conclusions: Estimated completion April 1, 2016.