Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
J Surg Res. 2020 Jan;245:309-314. doi: 10.1016/j.jss.2019.07.043. Epub 2019 Aug 14.
Pediatric postoperative opioid prescribing has come under scrutiny as a result of the ongoing opioid epidemic. Previous research has demonstrated that African American adults are less likely to receive analgesics, particularly opioids, after surgery, even after controlling for pain severity. We sought to examine racial disparities in the filling of opioid prescriptions by pediatric surgical patients after cholecystectomy.
We studied patients aged 1 to 18 y who were enrolled in Ohio Medicaid and underwent cholecystectomy. Procedures performed in January 2013-July 2016 were included. The percentage of patients who filled a postoperative opioid prescription within 14 d of their procedure was compared between black and white patients using log binomial regression models fit using generalized estimating equations to account for patient clustering within hospitals.
We identified 1277 patients who underwent a cholecystectomy. In unadjusted analyses, black children were significantly less likely than white children to fill an opioid prescription postoperatively (74.9% versus 85.7%, P < 0.001). After adjustment for patient-level clinical and demographic characteristics, we found that black children treated at non-children's hospitals in large-/medium-sized urban counties were significantly less likely to fill an opioid prescription after cholecystectomy when compared with white children treated at urban children's hospitals or to white children treated in non-children's hospitals in either large/medium urban counties or other counties. However, this association was partly explained by a longer average length of stay among black children.
Black children who undergo cholecystectomy at urban non-children's hospitals are less likely to fill a postoperative opioid prescription than white children who undergo cholecystectomy at those same hospitals or other hospitals. Further research is needed to identify whether this disparity is due to a lower rate of opioid prescribing or a lower rate of prescription filling.
由于阿片类药物流行，儿科术后开具阿片类药物处方受到了严格审查。先前的研究表明，即使在控制疼痛严重程度后，非裔美国成年人在手术后接受镇痛剂（尤其是阿片类药物）的可能性也较小。我们试图检查胆囊切除术后儿科手术患者阿片类药物处方填写的种族差异。
我们研究了在俄亥俄州医疗补助计划下接受胆囊切除术的 1 至 18 岁的患者。包括 2013 年 1 月至 2016 年 7 月进行的手术。使用对数二项式回归模型比较黑人和白人患者在手术后 14 天内填写术后阿片类药物处方的比例，使用广义估计方程拟合模型以考虑到医院内患者聚类。
我们确定了 1277 名接受胆囊切除术的患者。在未调整的分析中，黑人儿童术后开具阿片类药物处方的可能性明显低于白人儿童（74.9％比 85.7％，P <0.001）。在调整了患者的临床和人口统计学特征后，我们发现与在城市儿童医院接受治疗的白人儿童相比，在大城市/中型城市县的非儿童医院接受治疗的黑人儿童在胆囊切除术后更不可能开具阿片类药物处方，而与在大城市/中型城市县或其他县的非儿童医院接受治疗的白人儿童相比，在城市儿童医院接受治疗的白人儿童更不可能开具阿片类药物处方。但是，这种关联在一定程度上可以解释为黑人儿童的平均住院时间较长。
在城市非儿童医院接受胆囊切除术的黑人儿童，与在相同医院或其他医院接受胆囊切除术的白人儿童相比，不太可能填写术后阿片类药物处方。需要进一步研究以确定这种差异是由于阿片类药物处方的开具率较低还是处方的开具率较低所致。
