Department of Surgery, University of Wisconsin-Madison, WI.
Department of Surgery, University of Wisconsin-Madison, WI.
Surgery. 2019 Apr;165(4):838-842. doi: 10.1016/j.surg.2018.10.029. Epub 2018 Dec 1.
Pediatric umbilical hernia repair is a common procedure that requires minimal tissue disruption. We examined variation in opioid prescription fills after repair of uncomplicated umbilical hernias to characterize the types and doses of medication used and persistent postsurgical use.
Using the Truven Health Analytics MarketScan© Research Database for June 2012-September 2015, we identified pediatric patients undergoing umbilical hernia repair. We excluded patients with obstruction, gangrene, an earlier repair or a concurrent surgical procedure, and those without available pharmacy claim data. Analyses describe filled outpatient prescriptions by age, geographic region, drug type, quantity, and second prescriptions/refills.
Of 4,407 procedures performed, 2,292 patients (52%) filled a prescription for postoperative opioids (age 0-1 years: 21.6%, age 2-3 years: 51.5%, age 4-5 years: 54.3%, 6 years or older: 57.9% [P < .0001]). In the northeast United States, 42% of patients filled narcotic prescriptions, compared with 59% of patients in the south (P < .0001). Hydrocodone/acetaminophen was most commonly prescribed (51%), followed by codeine/acetaminophen (30%). Durations were ≤3 days (50%), 4-10 days (46%), and >10 days (4%). A total of 6% of patients filled a second opioid prescription within 30 days.
Although many patients do not require opioids for umbilical hernia repair, most pediatric patients fill opioid prescriptions, including for prolonged courses and refills. Guidelines for appropriate prescribing of opioids after common, simple procedures, such as umbilical hernia repair, could improve the quality of care for children and impact the US epidemic of opioid abuse.
小儿脐疝修补术是一种常见的手术，只需最小程度地破坏组织。我们研究了修补单纯脐疝后阿片类药物处方的开具情况，以了解所使用药物的类型和剂量，并评估术后的持续使用情况。
使用 Truven Health Analytics MarketScan© Research Database（2012 年 6 月至 2015 年 9 月），我们确定了接受脐疝修补术的小儿患者。我们排除了有梗阻、坏疽、之前修补或同时进行其他手术的患者，以及没有可用的药房理赔数据的患者。分析描述了按年龄、地理位置、药物类型、数量和第二张处方/续方来填写的门诊外用药处方。
在 4407 例手术中，2292 例患者（52%）开具了术后阿片类药物处方（0-1 岁：21.6%，2-3 岁：51.5%，4-5 岁：54.3%，6 岁或以上：57.9%[P<0.0001]）。在美国东北部，42%的患者开具了麻醉性阿片类药物处方，而南部的这一比例为 59%（P<0.0001）。最常开具的药物是氢可酮/对乙酰氨基酚（51%），其次是可待因/对乙酰氨基酚（30%）。用药时间≤3 天（50%）、4-10 天（46%）和>10 天（4%）。共有 6%的患者在 30 天内再次开具阿片类药物处方。
尽管许多患者在接受脐疝修补术后不需要使用阿片类药物，但大多数小儿患者都会开具阿片类药物处方，包括长期用药和续方。制定常见简单手术（如脐疝修补术）后阿片类药物合理使用指南，可改善儿童的护理质量，并对美国阿片类药物滥用流行产生影响。
