Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
Department of Pediatric Orthopedics, UCSF Benioff Children's Hospital Oakland, Oakland.
J Pediatr Orthop. 2021 Mar 1;41(3):e291-e295. doi: 10.1097/BPO.0000000000001736.
Understanding which pediatric patients seek opioid refills is crucial as prescription opioid use in childhood is associated with an increased risk of future opioid misuse. Orthopaedic surgeons are optimally positioned to lead the charge in addressing the opioid epidemic. The aim of this study was to describe the incidence of and risk factors associated with requiring opioid refills after pediatric orthopaedic surgery in children.
This retrospective case-control study included 1413 patients aged 0 to 18 years that underwent orthopaedic surgery at a single tertiary care children's hospital and were prescribed opioids at discharge. Using the state Prescription Drug Monitoring Program (PDMP) database, we determined which patients filled additional opioid prescriptions within 6 months following an orthopaedic procedure. Comparisons were made between patients that sought additional opioids and those that did not use bivariate analysis and binomial logistic regression.
In total, 31 (2.2%) patients sought additional opioid prescriptions a median 41 days postoperatively (range, 2 to 184). Nearly half of these patients obtained refills from providers outside of our institution, suggesting that previous reports using hospital records may underestimate its prevalence. Factors associated with requiring opioid refills included receiving hydromorphone [odds ratio (OR)=3.04, P=0.04] or methadone (OR=38.14, P<0.01) while inpatient, surgery on the axial skeleton (OR=5.42, P=0.01) or lower extremity (OR=2.49, P=0.04), and nonfracture surgery (OR=3.27, P=0.01). Patients who obtained additional opioids received significantly more opioids during their inpatient recovery (32.9 vs. 11.1 morphine equivalents, P<0.01).
Approximately 2% of children and families obtain additional opioids within 6 months of orthopaedic surgery. The volume of opioids during inpatient hospitalization may predict the need for opioid prescription refills after discharge. Clinicians should maximize efforts to achieve pain control with multimodal analgesia and opioid alternatives, and use caution when administering high-dose opioids during postoperative hospitalization.
Level III-prognostic.
了解哪些儿科患者需要开阿片类药物的续方至关重要，因为儿童时期处方类阿片药物的使用与未来阿片类药物滥用的风险增加有关。整形外科医生是解决阿片类药物流行的最佳人选。本研究的目的是描述儿童接受骨科手术后需要开阿片类药物续方的发生率和相关风险因素。
本回顾性病例对照研究纳入了在一家三级儿童专科医院接受骨科手术并在出院时开具阿片类药物的 1413 名 0 至 18 岁的患者。我们使用州级处方药物监测计划（PDMP）数据库，确定哪些患者在骨科手术后 6 个月内再次开了阿片类药物处方。通过二元分析和二项逻辑回归对需要额外阿片类药物的患者与不需要的患者进行比较。
共有 31 名（2.2%）患者在术后中位数 41 天（范围，2 至 184 天）时再次开了阿片类药物处方。这些患者中有近一半是从我们机构以外的提供者那里获得的续方，这表明以前使用医院记录的报告可能低估了其流行率。需要开阿片类药物续方的相关因素包括住院期间接受氢吗啡酮[比值比（OR）=3.04，P=0.04]或美沙酮（OR=38.14，P<0.01）、轴骨（OR=5.42，P=0.01）或下肢（OR=2.49，P=0.04）手术以及非骨折手术（OR=3.27，P=0.01）。获得额外阿片类药物的患者在住院康复期间接受的阿片类药物明显更多（32.9 与 11.1 吗啡当量，P<0.01）。
大约 2%的儿童及其家属在骨科手术后 6 个月内获得了额外的阿片类药物。住院期间阿片类药物的用量可能预测出院后开阿片类药物续方的需求。临床医生应通过多模式镇痛和阿片类药物替代物来最大程度地努力实现疼痛控制，并在术后住院期间谨慎使用高剂量阿片类药物。
III 级-预后。
