Billings Kathleen R, Manworren Renee C B, Lavin Jennifer, Stake Christine, Hebal Ferdynand, Leon Astrid H, Barsness Katherine
Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois.
Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois.
Laryngoscope Investig Otolaryngol. 2018 Dec 28;4(1):165-169. doi: 10.1002/lio2.237. eCollection 2019 Feb.
Identify demographic variables related to emergency department (ED) returns, and analgesic administration in the ED for postoperative pain after adenotonsillectomy (T&A).
Pediatric Health Information System (PHIS) database analysis.
Forty-seven children's hospitals included in the PHIS database were queried for all ED visits within 30 days of surgery with a diagnosis of acute postoperative pain (n = 2459) from 2014 to 2015. The subset of postoperative T&A patients (n = 861) was further analyzed for variables associated with return, and for pain management strategies, specifically opioids, employed by the ED.
Of the 2459 pediatric patients returning to the ED for acute postoperative pain, the largest subset included T&A patients (n = 861, 35%). Patients were seen an average of 4 days (SD 2.4) after their surgery. ED administration of opioids was not associated with gender, race, surgical diagnosis, or ethnicity. The rate of opioid administration by the ED increased with advancing age of the children analyzed ( = .01). The incidence was also higher for those with commercial versus Medicaid insurance carriers. A total of 204 (23.7%) patients received opioids while in the ED, 439 (51%) received both opioids and non-opioids, and only 51 (5.9%) received no pain medication.
T&A patients make up the largest subset of patients returning to the ED for postoperative pain. A total of 74.7% of patients receive opioids, either alone or in combination with non-opioids, on return to the ED. ED opioid administration was associated with older age of the child and payer, but not with gender, race, surgical diagnosis, or ethnicity.
确定与急诊复诊以及腺样体扁桃体切除术（T&A）术后疼痛在急诊使用镇痛药相关的人口统计学变量。
儿科健康信息系统（PHIS）数据库分析。
查询了PHIS数据库中纳入的47家儿童医院在2014年至2015年期间术后30天内诊断为急性术后疼痛的所有急诊就诊情况（n = 2459）。对术后T&A患者子集（n = 861）进一步分析与复诊相关的变量以及急诊采用的疼痛管理策略，特别是阿片类药物的使用情况。
在2459例因急性术后疼痛返回急诊的儿科患者中，最大的子集包括T&A患者（n = 861，35%）。患者术后平均4天（标准差2.4）前来就诊。急诊给予阿片类药物与性别、种族、手术诊断或种族无关。急诊给予阿片类药物的比例随着所分析儿童年龄的增长而增加（P = 0.01）。商业保险与医疗补助保险患者的发生率也更高。共有204例（23.7%）患者在急诊时接受了阿片类药物，439例（51%）患者同时接受了阿片类药物和非阿片类药物，只有51例（5.9%）患者未接受任何止痛药物。
T&A患者是返回急诊进行术后疼痛治疗的最大患者子集。共有74.7%的患者在返回急诊时单独或联合使用非阿片类药物接受了阿片类药物治疗。急诊给予阿片类药物与儿童年龄较大和付款人有关，但与性别、种族、手术诊断或种族无关。
4级。
