Division of Urology, Albany Medical College, 23 Hackett Boulevard, Albany, NY, 12208, USA.
Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, USA.
J Pediatr Urol. 2021 Oct;17(5):633.e1-633.e6. doi: 10.1016/j.jpurol.2021.07.006. Epub 2021 Jul 14.
Opioid abuse is a public health crisis, and often this starts postoperatively. Limited data are available on pediatric urology practitioners. We examined the likelihood of postoperative opioid prescriptions in our practice.
To determine rates of post-operative opioid prescriptions following urologic surgery in a tertiary academic center, and to identify what factors are related to opioid prescriptions.
We retrospectively reviewed opioid prescriptions for children who underwent a procedure in the operating room between 1/1/17 and 12/31/19. We collected data on gender, age, surgeon, procedure, length of stay, ethnicity, race, and whether opioids had been used pre-operatively. We grouped procedures into five categories: minor penile surgery, cystoscopic procedures, scrotal surgery, hypospadias repair/penoplasty, and pyeloplasty/ureteral reimplant. Multivariable logistic regression was used to determine odds ratios (OR) of opioid prescriptions.
1102 procedures had data available. 14.2% (n = 156) received opioid prescriptions. Using minor penile surgery as a baseline, scrotal surgery increased the odds of an opioid by 1.42; hypospadias, pyeloplasty, and other procedures reduced the odds by 0.53, 0.55, and 0.54, respectively (no patient received opioids for endoscopic procedures). Ambulatory procedures had a lower rate of opioids (0.40), and age was a major factor, with the odds of a prescription increasing by a factor of 1.45 per year of age. Since January of 2017, the opioid prescription rate has decreased from 18% in 2017 to 7.7% in 2019.
We found a relatively low rate of opioid prescribing in our pediatric patients, mostly in older children undergoing penile and scrotal procedures. Our rate was comparable to several other institutions that have examined their prescription rates in surgical patients. Heightened awareness has resulted in decreased opioid usage over time (to 6.9%). Limitations included the retrospective nature of our study, which did not allow us to assess whether pain control was adequate or if the opioids prescribed were used by patients. Opioids are rarely needed in pediatric patients.
85.8% of post-operative pediatric urology patients at our institution were not provided with prescription opioids. Factors associated with a higher likelihood of receiving a prescription were increasing age and scrotal surgery.
阿片类药物滥用是一个公共卫生危机，而且这种情况通常始于术后。关于小儿泌尿科医生的相关数据非常有限。我们研究了我们的实践中术后开具阿片类药物处方的可能性。
确定在三级学术中心进行泌尿科手术后开具阿片类药物处方的比率，并确定与阿片类药物处方相关的因素。
我们回顾性地审查了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间在手术室接受手术的儿童的阿片类药物处方。我们收集了有关性别、年龄、外科医生、手术、住院时间、种族、民族和术前是否使用阿片类药物的数据。我们将手术分为五类：阴茎小手术、膀胱镜检查、阴囊手术、尿道下裂修复/阴茎成形术、肾盂成形术/输尿管再植术。多变量逻辑回归用于确定阿片类药物处方的优势比（OR）。
1102 例手术数据可用。14.2%（n=156）接受了阿片类药物处方。以阴茎小手术为基础，阴囊手术使阿片类药物处方的可能性增加了 1.42 倍；尿道下裂、肾盂成形术和其他手术分别使阿片类药物处方的可能性降低了 0.53、0.55 和 0.54（无患者接受内镜检查手术的阿片类药物）。日间手术的阿片类药物处方率较低（0.40），年龄是一个主要因素，每增加 1 岁，开处方的可能性增加 1.45 倍。自 2017 年 1 月以来，阿片类药物处方率从 2017 年的 18%下降到 2019 年的 7.7%。
我们发现我们的小儿患者开阿片类药物的比例相对较低，主要是在接受阴茎和阴囊手术的大龄儿童中。我们的比率与其他几家检查手术患者处方率的机构相似。随着时间的推移，（医疗）意识的提高导致阿片类药物的使用减少（降至 6.9%）。限制包括我们的研究是回顾性的，这使我们无法评估疼痛控制是否充分或患者是否使用了开的阿片类药物。在小儿患者中，阿片类药物很少需要。
我们机构 85.8%的术后小儿泌尿科患者未开具阿片类药物处方。与更高的处方可能性相关的因素是年龄增加和阴囊手术。
