Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.
Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria.
Br J Anaesth. 2021 Jun;126(6):1192-1199. doi: 10.1016/j.bja.2020.12.044. Epub 2021 Feb 24.
The opioid epidemic is one of the most pressing public health crises in the USA. With fractures being amongst the most common reasons for a child to require surgical intervention and receive post-surgical pain management, characterisation of opioid prescription patterns and risk factors is critical. We hypothesised that the numbers of paediatric patients receiving opioids, or who developed persistent opioid use, are significant, and a number of risk factors for persistent opioid use could be identified.
We conducted a retrospective population-based cohort study. National claims data from the Truven Health Analytics® MarketScan database were used to (i) characterise opioid prescription patterns and (ii) describe the epidemiology and risk factors for single use and persistent use of opioids amongst paediatric patients who underwent surgical intervention for fracture treatment.
Amongst 303 335 patients, 21.5% received at least one opioid prescription within 6 months after surgery, and 1671 (0.6%) developed persistent opioid use. Risk factors for persistent opioid use include older age; female sex; lower extremity trauma; surgeries involving the spine, rib cage, or head; closed fracture treatment; earlier surgery years; previous use of opioid; and higher comorbidity burden.
Amongst a cohort of paediatric patients who underwent surgical fracture treatment, 21.5% filled at least one opioid prescription, and 0.6% (N=1671) filled at least one more opioid prescription between 3 and 6 months after surgery. Understanding risk factors related to persistent opioid use can help clinicians devise strategies to counter the development of persistent opioid use for paediatric patients.
阿片类药物滥用危机是美国目前面临的最严峻的公共卫生危机之一。骨折是儿童接受手术干预和接受术后疼痛管理的最常见原因之一，因此，描述阿片类药物处方模式和相关风险因素至关重要。我们假设接受阿片类药物治疗的儿童数量或发展为持续性阿片类药物使用的儿童数量是巨大的，并且可以确定一些持续性阿片类药物使用的风险因素。
我们进行了一项回顾性基于人群的队列研究。使用 Truven Health Analytics® MarketScan 数据库中的全国索赔数据，（i）描述接受手术治疗骨折的儿童的阿片类药物处方模式，（ii）描述其流行病学特征以及单次和持续性使用阿片类药物的风险因素。
在 303335 名患者中，21.5%的患者在手术后 6 个月内至少开具了一张阿片类药物处方，1671 名（0.6%）患者发展为持续性阿片类药物使用。持续性阿片类药物使用的风险因素包括年龄较大；女性；下肢创伤；涉及脊柱、肋骨或头部的手术；闭合性骨折治疗；手术时间较早；先前使用过阿片类药物；以及更高的合并症负担。
在接受手术治疗骨折的儿童队列中，21.5%的患者至少开具了一张阿片类药物处方，0.6%（n=1671）的患者在手术后 3 至 6 个月内又开具了至少一张阿片类药物处方。了解与持续性阿片类药物使用相关的风险因素可以帮助临床医生制定策略，以防止儿童持续性阿片类药物使用的发生。
