The Adolescent Surgery Experience: Preoperative Anticipatory Guidance and Postoperative Opioid Misuse (POM) - PROJECT SUMMARY Each year, over 1.4 million US adolescents undergo surgery. Between 3-5% of opioid-naïve adolescents continue to fill opioid prescriptions 3-6 months after surgery, which is long after acute surgical pain has resolved and may signify a new opioid use disorder. Due to complex biopsychosocial changes, there is significant concern among experts that adolescents may be at increased risk of perioperative opioid-related adverse outcomes, including postoperative opioid misuse (POM), defined as use after severe surgical pain resolves (>14 days after surgery), opioid use disorder and overdose. Anticipatory guidance is endorsed by the American Academy of Pediatrics for risk prevention among adolescents. It is routinely utilized in outpatient pediatric settings to prevent high-risk behaviors, including those related to opioid and substance use. However, anticipatory guidance, with its educational and behavioral components, has not been studied in the perioperative setting. To gather preliminary data, the principal investigator, Dr. Sutherland, completed an observational study of 501 adolescents with six months of follow-up at the Children’s Hospital of Philadelphia (CHOP). Among patients undergoing reconstructive knee surgery (ligament repair), 8% used any opioids in Week 2 after surgery, but 44% endorsed opioid use (median 5 days) in Weeks 3 and 4, consistent with unintended opioid misuse; interviews suggest use was associated with anxiety and uncertainty over recovery. The central objective for this proposal is to improve knowledge of effective anticipatory guidance techniques and design an intervention to prevent POM that is both adolescent-centered and reflective of perioperative considerations that will be evaluated in a subsequent R01- funded trial. This proposal includes: (1) a retrospective cohort study to establish contemporary (pandemic-era) dispensing trends and determine the association between patient characteristics and adverse opioid-related outcomes, (2) semi-structured interviews with surgeons, who vary in opioid dispensing practices, and adolescent-caregiver dyads to characterize effective surgical anticipatory guidance and POM themes to inform an adolescent-centered intervention, and (3) a single-arm feasibility study to measure acceptability of an anticipatory guidance intervention to prevent POM. With this proposal, Dr. Sutherland’s overarching career goal is to develop as a clinical trialist focused on prevention trials. To accomplish this, she seeks to gain additional training in the following domains: (1) use of population data to inform trial design (2) qualitative methodology to inform intervention design and (3) foundation in clinical trial design and conduct. Dr. Sutherland will conduct the proposed research at the Children’s Hospital of Philadelphia within the University of Pennsylvania and is supported by mentors, advisors and consultants with significant experience in trial design, specifically pragmatic and prevention trials, advanced biostatistical analysis, application of qualitative data to intervention design, adolescent psychology and addiction medicine.
