Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
J Pediatr Surg. 2019 Oct;54(10):1984-1987. doi: 10.1016/j.jpedsurg.2019.02.008. Epub 2019 Feb 28.
Opioid misuse has reached epidemic proportions, and postoperative opioids have been linked to overdose, diversion, and dependency. We recently found our opioid prescribing practices following common pediatric operations to be inconsistent and excessive. In this study, we evaluate the efficacy of an educational intervention on opioid prescriptions following tonsillectomy and hernia repair.
Retrospective chart review of prescriptions following outpatient tonsillectomies and hernia repairs at a single institution before and after an educational intervention was performed. The intervention consisted of a single campus-wide grand rounds presentation detailing the surgeon's role in the opioid epidemic.
Postoperative opioid prescriptions were significantly reduced for hernia repair following the educational intervention: 4.2 ± 2.9 vs 2.7 ± 2.6 days' supply (p = 0.004). Such a reduction was not observed for post-tonsillectomy opioid prescriptions: 6.3 ± 4.4 vs 5.4 ± 3.0 days' supply (p = 0.226). A greater decrease in interprovider variation was observed for hernia providers after the educational intervention than for tonsillectomy providers, though significant variation continued to be present for both procedures after the intervention.
The efficacy of an educational intervention at reducing postoperative pediatric opioid prescribing may be tied to the specialty-specific role model relationship of the educator to the prescriber.
retrospective comparative chart review.
IV.
阿片类药物滥用已达到流行程度，术后阿片类药物与过量用药、药物转移和依赖有关。我们最近发现，我们在进行常见儿科手术后的阿片类药物处方实践不一致且过度。在这项研究中，我们评估了针对扁桃体切除术和疝修补术后阿片类药物处方的教育干预的效果。
在单机构内对门诊扁桃体切除术和疝修补术的处方进行回顾性图表审查，在实施教育干预之前和之后。干预措施包括一次校园范围内的大查房演示，详细介绍了外科医生在阿片类药物流行中的作用。
疝修补术后的阿片类药物处方显著减少：4.2±2.9 天与 2.7±2.6 天（p=0.004）。扁桃体切除术后的阿片类药物处方未观察到这种减少：6.3±4.4 天与 5.4±3.0 天（p=0.226）。教育干预后，疝提供者的提供者间变异性减少幅度大于扁桃体切除术提供者，但干预后两种手术的变异性仍然存在。
教育干预在减少儿科术后阿片类药物处方方面的效果可能与教育者与处方者之间的专业特定榜样关系有关。
回顾性比较图表审查。
IV。
