SC CTSI support improves understanding of post-surgery opioid prescribing for children

Patient on bed

No one wants to see a child in physical pain, but post-surgery treatment with opioids poses risks for addiction or other misuses. Surgeons have lacked effective guidance about prescribing opioids to manage a child’s pain after surgery. Now Lorraine Kelley-Quon, MD, MSHS, FACS, FAAP, (https://bit.ly/2StAqc6) a former SC CTSI KL2 Mentored Career Development Scholar, is helping to fill that knowledge gap. She led an expert panel to produce the first-ever set of guidelines for post-surgery opioid prescribing for children and adolescents.

Her next project is to help families better understand safe opioid prescription use, storage, and disposal.

“Each family should have this safety information provided to them in an accessible, understandable way, and they need to be engaged before and after surgery,” said Kelley-Quon, a pediatric surgeon at Children’s Hospital Los Angeles (CHLA) and Assistant Professor of clinical surgery at the Keck School of Medicine of the University of Southern California. She operates on all ages of children from premature infants to teenagers and holds an M.S. in health services research.

Kelley-Quon credits her affiliation with SC CTSI, which provided crucial funding and resources, for aiding her research. “I'm personally grateful for the CTSI being so supportive of this work,” she said.

Cecilia Patino-Sutton, MD, MEd, PhD, (https://bit.ly/3vV39Em) SC CTSI Workforce Development Director and Co-Director of the KL2 Program echoed this sentiment. “Lorraine Kelley-Quon is an exceptional and model clinical translational researcher who has harnessed every opportunity of the KL2 program to advance her career as a surgeon-scientist, which has already lead to impacting the health of children affected by the opioid pandemic locally and nationally. We are so proud of her,” said Patino-Sutton.

During her surgical training, she noticed that some children she treated came from homes afflicted with substance abuse, particularly opioid abuse. But data were lacking on risk factors for prescription opioid misuse following pediatric surgery. Kelley-Quon began thinking about her prescribing practices as a young surgeon. “I was inspired to look at this from a research perspective.”

In 2018, she began a three-year SC CTSI KL2 fellowship to study postoperative opioid use in adolescents and identify predictors of use, abuse, diversion, and conversion to chronic use.

“The KL2 fellowship was instrumental in enabling me to partner with addiction scientists to use some of the data that they had previously generated,” she said. “The misuse of various substances by adolescents had been surveyed and studied for decades, including prescription opioid misuse. But surgeons and other healthcare providers are less often aware of this data.”

In 2018, she received a SC CTSI team science award to create a multidisciplinary group of experts to review scientific publications on opioid usage and risk in pediatric surgical populations. In a November 2020 article published in JAMA Surgery and endorsed by the American Pediatric Surgical Association.

“Dr. Kelley-Quon was awarded a team building voucher from the SC CTSI and utilized the principles of team science to engage pain and addiction specialists and other surgeons to develop an important opioid use and prescribing guideline to help parents and teens understand how to properly store and dispose opioid use after surgery,” said Sarah Hamm-Alvarez, Ph.D., Associate Dean for Basic and Translational Research and Director of the SC CTSI Research Development core.

Kelley-Quon and her colleagues outline 20 recommendations for safer post-surgery pain management in children and adolescents.

“These guidelines are meant to help healthcare providers understand the risks associated with prescription opioid use in youth and to maximize all the non-opioid interventions that we have,” she said.

Her next research goal is to learn from families how best to guide them safely through post-surgery pain management. “I’m recruiting focus groups specifically reaching out to a diverse group of families to talk about the guidelines project,” Kelley-Quon said. “We need to think creatively about ways we can educate and engage families before and after surgery on safe opioid use, storage, and disposal.”