阿片类药物使用与行幽门肌切开术婴儿结局的相关性。
The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy.
机构信息
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Fetal and Neonatal Institute, Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
出版信息
Clin Ther. 2019 Sep;41(9):1690-1700. doi: 10.1016/j.clinthera.2019.07.002. Epub 2019 Aug 10.
PURPOSE
The purpose of this study was to describe the frequency and variation of opioid use across hospitals in infants undergoing pyloromyotomy and to determine the impact of opioid use on postoperative outcomes.
METHODS
A retrospective cohort study (2005-2015) was conducted by using the Pediatric Health Information System (PHIS) database, including infants (aged <6 months) with pyloric stenosis who underwent pyloromyotomy. Infants with significant comorbidities were excluded. Opioid use was classified as a patient receiving at least 1 opioid medication during his or her hospital stay and categorized as preoperative, day of surgery, or postoperative (≥1 day after surgery). Outcomes included prolonged hospital length of stay (LOS; ≥3 days) and readmission within 30 days.
FINDINGS
Overall, 25,724 infants who underwent pyloromyotomy were analyzed. Opioids were administered to 6865 (26.7%) infants, with 1385 (5.4%) receiving opioids postoperatively. In 2015, there was significant variation in frequency of opioid use by hospital, with 0%-81% of infants within an individual hospital receiving opioids (P < 0.001). Infants only receiving opioids on the day of surgery exhibited decreased odds of prolonged hospital LOS (odds ratio [OR], 0.85; 95% CI, 0.78-0.92). Infants who received an opioid on both the day of surgery and postoperatively exhibited increased odds of a prolonged hospital LOS (OR, 1.71; 95% CI, 1.33-2.20). Thirty-day readmission was not associated with opioid use (OR, 1.03; 95% CI, 0.93-1.14).
IMPLICATIONS
There is national variability in opioid use for infants undergoing pyloromyotomy, and postoperative opioid use is associated with prolonged hospital stay. Nonopioid analgesic protocols may warrant future investigation.
目的
本研究旨在描述接受幽门肌切开术的婴儿在各医院中阿片类药物使用的频率和变化，并确定阿片类药物使用对术后结果的影响。
方法
采用儿科健康信息系统（PHIS）数据库进行回顾性队列研究（2005-2015 年），纳入接受幽门肌切开术的婴儿（<6 个月龄）。排除有显著合并症的婴儿。将阿片类药物的使用定义为患者在住院期间至少接受 1 种阿片类药物，并将其分为术前、手术当天和术后（手术结束后≥1 天）。结果包括住院时间延长（≥3 天）和 30 天内再入院。
结果
共分析了 25724 例接受幽门肌切开术的婴儿。6865 例（26.7%）婴儿给予阿片类药物，其中 1385 例（5.4%）术后给予阿片类药物。2015 年，各医院阿片类药物使用频率存在显著差异，单个医院内 0%-81%的婴儿接受阿片类药物（P<0.001）。仅在手术当天使用阿片类药物的婴儿住院时间延长的可能性降低（比值比 [OR]，0.85；95%CI，0.78-0.92）。在手术当天和术后均使用阿片类药物的婴儿住院时间延长的可能性增加（OR，1.71；95%CI，1.33-2.20）。30 天再入院与阿片类药物使用无关（OR，1.03；95%CI，0.93-1.14）。
结论
接受幽门肌切开术的婴儿阿片类药物的使用存在全国性差异，术后阿片类药物的使用与住院时间延长有关。非阿片类镇痛药方案可能需要进一步研究。
Zotero 插件