Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
J Surg Res. 2019 Mar;235:404-409. doi: 10.1016/j.jss.2018.09.085. Epub 2018 Nov 16.
Adolescents who use prescription opioids have an increased risk for future drug abuse and overdose, making them a high-risk population. Appendectomy is one of the most common surgical procedures in this age group, often requires opioid analgesia, and is performed by both pediatric and general surgeons. Prescription patterns comparing these two provider groups have not yet been evaluated; we hypothesize that general surgery providers prescribe more opioids for adolescent and young adult patients than do pediatric surgery providers.
A retrospective chart review was conducted across a single health system consisting of four hospitals. All uncomplicated laparoscopic appendectomies performed between January 1, 2016 and August 14, 2017 on patients aged 7-20 were included for analysis. Any case coded for multiple procedures, identified as converted to open, or had a length of stay >48 h were excluded. The primary outcome measure was amount of opioid prescribed postoperatively. To standardize different formulations and types of analgesia prescribed, prescriptions were converted into oral morphine equivalents (OMEs). For reference, one 5 mg pill of oxycodone equals 7.5 OME. Linear regression was performed controlling for patient weight, gender, race, insurance status, provider type (pediatric versus general surgery), and provider level (resident, advanced practice provider, and attending).
A total of 336 pediatric laparoscopic appendectomies were analyzed, 148 by general surgeons and 188 by pediatric surgeons. Pediatric surgeons prescribed less opioid than general surgeons overall (59 OME versus 90 OME, P < 0.0001). For patients aged <13 y, there was no significant difference between pediatric (26 OME) and general (37 OME, P = 0.8921) surgeons. However, for the age group 13-20 y, pediatric surgeons prescribed 25% less opioid than general surgeons (90 OME versus 112.5 OME, P < 0.0001). Regression analysis demonstrated that being cared for by a general surgery service (+24.1 OME [95% confidence interval 9.8-38.3]) was associated with high prescribing, whereas having Medicaid was associated with lower prescription amounts (-16.4 OME [95% confidence interval -32.5 to -0.3]).
After an uncomplicated laparoscopic appendectomy, general surgeons prescribe significantly more opioid to adolescent patients than do pediatric surgeons, even when controlling for age and weight. One substantial and modifiable contributor of the opioid epidemic is the amount of opioid prescribed. The variability of prescribing habits to adolescents and young adults demonstrates a clear need for increased education and guidelines on this topic, especially for surgeons who do not frequently treat the younger and more vulnerable population.
使用处方类阿片的青少年未来发生药物滥用和药物过量的风险增加，因此他们属于高危人群。阑尾切除术是该年龄段最常见的手术之一，通常需要阿片类镇痛药，并且由儿科和普通外科医生进行。目前尚未评估这两组医生的处方模式；我们假设普通外科医生为青少年和年轻患者开具的阿片类药物比儿科外科医生多。
对单家医疗系统（由 4 家医院组成）进行回顾性图表审查。分析了 2016 年 1 月 1 日至 2017 年 8 月 14 日期间接受腹腔镜阑尾切除术且年龄在 7-20 岁之间的所有无并发症的患者。排除了因多种手术、中转开腹或住院时间>48 小时而被编码的任何病例。主要观察指标是术后开具的阿片类药物的数量。为了标准化不同的配方和类型的镇痛药物，将处方转换为口服吗啡当量（OMEs）。参考标准，一片 5 毫克的羟考酮相当于 7.5 OME。进行线性回归分析，控制患者体重、性别、种族、保险状况、医生类型（儿科医生与普通外科医生）和医生级别（住院医师、高级实践医师和主治医生）。
共分析了 336 例儿科腹腔镜阑尾切除术，其中 148 例由普通外科医生进行，188 例由儿科外科医生进行。总体而言，儿科外科医生开具的阿片类药物比普通外科医生少（59 OME 与 90 OME，P<0.0001）。对于年龄<13 岁的患者，儿科医生（26 OME）与普通外科医生（37 OME，P=0.8921）之间没有显著差异。然而，对于 13-20 岁的年龄组，儿科外科医生开具的阿片类药物比普通外科医生少 25%（90 OME 与 112.5 OME，P<0.0001）。回归分析表明，由普通外科医生治疗（+24.1 OME [95%置信区间 9.8-38.3]）与开具大剂量处方有关，而 Medicaid 保险与开具低剂量处方有关（-16.4 OME [95%置信区间 -32.5 至 -0.3]）。
在接受腹腔镜阑尾切除术治疗后，即使控制了年龄和体重，普通外科医生为青少年患者开具的阿片类药物剂量也明显高于儿科外科医生。阿片类药物处方数量是阿片类药物滥用的一个重要且可改变的因素。儿科和年轻患者的处方习惯存在明显差异，这表明在这一主题上需要加强教育和制定指南，尤其是对于那些不经常治疗年龄较小和更脆弱人群的外科医生。
