O3250: Opioid Use After Screw Fixation of Slipped Capital Femoral Epiphysis

Background: Slipped femoral capital epiphysis (SCFE) is a common pediatric hip disorder primarily managed with screw fixation to prevent further slippage. Opioid pain medication is often utilized post-operatively, but there is little evidence to guide prescribing practices. Pediatric and adolescent opioid exposure is correlated with future opioid abuse and oversupply is a major contributing factor to the current opioid crisis. SCFE patients commonly report significantly improved pain postoperatively, likely secondary to physeal stabilization. The purpose of this study was to describe narcotic requirements and prescribing practices for patients after screw fixation of SCFE.

Methods: An observational prospective cohort study involving patients aged 8-17 years old with SCFE who underwent screw fixation was conducted. We excluded patients who underwent surgical osteotomy or open reduction, and those who had cognitive disability or other concomitant injuries impeding accurate pain assessments. Type and quantity of pain medications prescribed were at the surgeon’s discretion. Patients were contacted on postoperative days (POD) 1, 3, and 5 for data collection. Post-discharge analgesic use, pain severity using a parental proxy, and pain control satisfaction were recorded. Analysis and figures were produced with GraphPad Prism version 10.0.2 (GraphPad Software, La Jolla, CA).

Results: Thirty patients have been enrolled, with 4 lost to follow-up. The remaining 26 had an average age of 12.4±1.6 years and average BMI of 29.0±4.6. Three of these were unstable by the Loder Classification System (unable to bear weight with or without crutches) and 4 had Southwick slip angles exceeding 50°. In total, 225 opioid doses (equaling 1,507.5 morphine milliequivalents (MME)) were prescribed upon discharge. Of these, just 20 doses (146 MME) were utilized. This equated to an average of 8.7±4.9 doses (58.0±33.5 MME) of opioids prescribed per patient compared to an average of 0.8±1.2 doses (5.6±8.9 MME) utilized per patient (p < 0.0001). The maximum number of opioid doses utilized by any patient following discharge was 3. 88.5% of patients reported improved pain on postoperative day 1 compared to preoperatively, 3.8% reported it as the same, and 7.7% reported worse pain. Of the 11 patients who utilized opioids following discharge, only 1 received the maximum scheduled dose of non-opioid analgesia (acetaminophen and ibuprofen). Opioid utilization did not appear to be related to slip angle severity, symptom chronicity, or ability to bear weight (Table 1).

Conclusion: Over-prescription of opioids occurs following this procedure, introducing oversupply into the population and potentially contributing to the opioid crisis. With adequate non-opioid analgesia counseling and utilization, empiric outpatient opioid prescriptions following screw fixation of SCFE are unnecessary. Given incidence of SCFE at 10.8/100,000, extrapolating these results to a national and international scale would dramatically limit the number of opioids prescribed and available for misuse.