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Scientific Oral Presentation

Pediatric Otolaryngology

Clinical and Economic Impact of Non-opioid Analgesia Guidelines in Pediatric Adenotonsillectomy: A Multi-institutional Database Study

Sunday, October 18, 2026
11:18 AM - 11:24 AM PT
Location: 409AB

    Presenting Author(s)

  • Daniel J. Campbell, MD

    Otolaryngology Resident Physician
    Thomas Jefferson University Hospitals
    Philadelphia, PA, United States

    • Co-Author(s)

  • Leonard E. Estephan, MD

    Otolaryngology Resident
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • Emma P. Tam, BA

    Medical Student
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • WP

    William Parkes, MD

    Pediatric Otolaryngologist
    Nemours Children's Health, United States

  • Nicole L. Aaronson, MD, MBA

    Chief, Pediatric Otolaryngology
    Nemours Children's Hospital of Delaware
    Wilmington, DE, United States

    • Senior Author(s)

  • HN

    Heather C. Nardone, MD

    Pediatric Otolaryngologist
    Nemours Children's Health
    Wilmington, DE, United States

Disclosure(s):
Nicole L. Aaronson, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pediatric adenotonsillectomy (AT) postoperative pain management has systemically shifted away from routine opioid prescription following the 2019 AAO-HNS clinical practice guideline on tonsillectomy. This study evaluates the paradigm shift’s impact on recovery limiting complications and healthcare costs.

Methods: A multi-institutional retrospective cohort analysis was performed using the TriNetX database. Patients < 18 years old undergoing AT were stratified by surgical year: pre-2019 (Jan 2014–Dec 2017) or post-2019 (Jan 2021–Dec 2025). Opioid prescription data was recorded. Using 1:1 propensity score matching (PSM), the incidence of postoperative dehydration, hemorrhage, throat pain, intravenous (IV) fluid administration, and emergency department (ED) visits were compared. A number needed to treat (NNT) analysis was performed based on inflation-adjusted costs per ED visit to estimate economic cost savings.

Results: Following 1:1 PSM (n=66,844 per cohort), the pre-2019 cohort demonstrated significantly higher risk ratios (RR) of dehydration (1.27; 95% CI 1.17-1.38), IV fluid needs (1.27; 95% CI 1.17-1.37), ED visits (1.21; 95% CI 1.16-1.27), and nausea/vomiting (1.24; 95% CI 1.12-1.39) compared to the post-2019 cohort (p < 0.0001). Postoperative hemorrhage rates were statistically stable (p=0.145). Post-2019 opioid prescriptions decreased significantly (RR 1.47; 95% CI 1.44-1.50; p< 0.0001), notably with a 25-fold reduction in codeine prescriptions. The NNT to prevent one ED visit was 101.7, resulting in an estimated cost avoidance of $3.2 million within the studied cohort.

Conclusions: Shifting to opioid-sparing protocols reduces dehydration, pain, and ED utilization without increasing hemorrhage risk. These findings validate the 2019 guidelines, confirming that medication stewardship improves outcomes and offers significant economic value.