Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA.
Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Ann Surg. 2020 Dec;272(6):1149-1157. doi: 10.1097/SLA.0000000000003171.
To describe variability in and consequences of opioid prescriptions following pediatric laparoscopic appendectomy.
Postoperative opioid prescribing patterns may contribute to persistent opioid use in both adults and children.
We included children <18 years enrolled as dependents in the Military Health System Data Repository who underwent uncomplicated laparoscopic appendectomy (2006-2014). For the primary outcome of days of opioids prescribed, we evaluated associations with discharging service, standardized to the distribution of baseline covariates. Secondary outcomes included refill, Emergency Department (ED) visit for constipation, and ED visit for pain.
Among 6732 children, 68% were prescribed opioids (range = 1-65 d, median = 4 d, IQR = 3-5 d). Patients discharged by general surgery services were prescribed 1.23 (95% CI = 1.06-1.42) excess days of opioids, compared with those discharged by pediatric surgery services. Risk of ED visit for constipation (n = 61, 1%) was increased with opioid prescription [1-3 d, risk ratio (RR) = 2.46, 95% CI = 1.31-5.78; 4-6 d, RR = 1.89, 95% CI = 0.83-4.67; 7-14 d, RR = 3.75, 95% CI = 1.38-9.44; >14 d, RR = 6.27, 95% CI = 1.23-19.68], compared with no opioid prescription. There was similar or increased risk of ED visit for pain (n = 319, 5%) with opioid prescription [1-3 d, RR = 1.00, 95% confidence interval (CI) = 0.74-1.32; 4-6 d, RR = 1.31, 95% CI = 0.99-1.73; 7-14 d, RR = 1.52, 95% CI = 1.00-2.18], compared with no opioid prescription. Likewise, need for refill (n = 157, 3%) was not associated with initial days of opioid prescribed (reference 1-3 d; 4-6 d, RR = 0.96, 95% CI = 0.68-1.35; 7-14 d, RR = 0.91, 95% CI = 0.49-1.46; and >14 d, RR = 1.22, 95% CI = 0.59-2.07).
There was substantial variation in opioid prescribing patterns. Opioid prescription duration increased risk of ED visits for constipation, but not for pain or refill.
描述小儿腹腔镜阑尾切除术后阿片类药物处方的变异性及其后果。
术后阿片类药物的开具模式可能导致成年人和儿童持续使用阿片类药物。
我们纳入了在军事卫生系统数据存储库中作为受抚养人登记的<18 岁接受单纯腹腔镜阑尾切除术（2006-2014 年）的儿童。对于开出的阿片类药物天数这一主要结局，我们根据基线协变量的分布进行了与出院科室相关的评估。次要结局包括药物再开、因便秘到急诊就诊（ED）和因疼痛到 ED 就诊。
在 6732 名儿童中，68%的患儿开具了阿片类药物（范围=1-65 天，中位数=4 天，IQR=3-5 天）。与儿科手术服务出院的患儿相比，由普通外科服务出院的患儿开具的阿片类药物处方多 1.23 天（95%CI=1.06-1.42）。开具阿片类药物会增加因便秘到 ED 就诊的风险（n=61，1%）[1-3 天，风险比（RR）=2.46，95%CI=1.31-5.78；4-6 天，RR=1.89，95%CI=0.83-4.67；7-14 天，RR=3.75，95%CI=1.38-9.44；>14 天，RR=6.27，95%CI=1.23-19.68]，与未开具阿片类药物相比。开具阿片类药物与因疼痛到 ED 就诊的风险（n=319，5%）相似或增加[1-3 天，RR=1.00，95%置信区间（CI）=0.74-1.32；4-6 天，RR=1.31，95%CI=0.99-1.73；7-14 天，RR=1.52，95%CI=1.00-2.18]，与未开具阿片类药物相比。同样，药物再开（n=157，3%）的需求与最初开具的阿片类药物天数无关（参考 1-3 天；4-6 天，RR=0.96，95%CI=0.68-1.35；7-14 天，RR=0.91，95%CI=0.49-1.46；>14 天，RR=1.22，95%CI=0.59-2.07）。
阿片类药物的开具模式存在较大差异。阿片类药物的开具时间与因便秘到 ED 就诊的风险增加有关，但与疼痛或药物再开无关。
