Department of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA.
Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Sacramento, USA.
Pediatr Surg Int. 2021 May;37(5):659-665. doi: 10.1007/s00383-020-04846-2. Epub 2021 Jan 12.
Prescription drug monitoring programs (PDMPs) have been established to combat the opioid epidemic, but there is no data on their efficacy in children. We hypothesized that a statewide PDMP mandate would be associated with fewer opioid prescriptions in pediatric surgical patients.
Patients < 18 undergoing inguinal hernia repair, orchiopexy, orchiectomy, appendectomy, or cholecystectomy at a tertiary children's hospital were included. The primary outcome, discharge opioid prescription, was compared for 10 months pre-PDMP (n = 158) to 10 months post-PDMP (n = 228). Interrupted time series analysis was performed to determine the effect of the PDMP on opioid prescribing.
Over the 20-month study period, there was an overall decrease in the rate of opioid prescriptions per month (- 3.6% change, p < 0.001). On interrupted time series analysis, PDMP implementation was not associated with a significant decrease in the monthly rate of opioid prescriptions (1.27% change post-PDMP, p = 0.4). However, PDMP implementation was associated with a reduction in opioid prescriptions of greater than 5 days' supply (- 2.7% per month, p = 0.03).
Opioid prescriptions declined in pediatric surgical patients over the study time period. State-wide PDMP implementation was associated with a reduction in postoperative opioid prescriptions of more than 5 days' duration.
为了应对阿片类药物泛滥的问题，已经建立了处方药物监测计划（PDMP），但目前还没有针对儿童的 PDMP 疗效数据。我们假设全州范围内的 PDMP 指令将与儿科手术患者的阿片类药物处方数量减少相关。
研究纳入了在一家三级儿童医院接受腹股沟疝修补术、睾丸固定术、睾丸切除术、阑尾切除术或胆囊切除术的<18 岁患者。主要结局为出院时的阿片类药物处方，比较了 PDMP 前 10 个月（n=158）和 PDMP 后 10 个月（n=228）的数据。采用中断时间序列分析来确定 PDMP 对阿片类药物处方的影响。
在 20 个月的研究期间，每月开具阿片类药物处方的比例总体呈下降趋势（-3.6%的变化，p<0.001）。在中断时间序列分析中，PDMP 的实施与每月阿片类药物处方率的显著下降无关（PDMP 实施后每月变化 1.27%，p=0.4）。然而，PDMP 的实施与超过 5 天供应的阿片类药物处方减少相关（每月减少 2.7%，p=0.03）。
在研究期间，儿科手术患者的阿片类药物处方数量下降。全州范围内 PDMP 的实施与术后阿片类药物处方超过 5 天的持续时间减少有关。
