Department of Surgery, The Medical University of South Carolina, 10 McClennan Banks Drive, MSC 918 | SJCH 2190, Charleston, SC 29425, USA.
Department of Public Health Sciences, The Medical University of South Carolina, Charleston, SC, USA.
J Pediatr Surg. 2022 Dec;57(12):912-919. doi: 10.1016/j.jpedsurg.2022.04.019. Epub 2022 May 2.
The past 5 years have witnessed a concerted national effort to assuage the rising tide of the opioid misuse in our country. Surgical procedures often serve as the initial exposure of children to opioids, however the trajectory of use following these exposures remains unclear. We hypothesized that opioid exposure following appendectomy would increase the risk of persistent opioid use among publicly insured children.
A retrospective longitudinal cohort study was conducted on South Carolina Medicaid enrollees who underwent appendectomy between January 2014 and December 2017 using administrative claims data. The primary outcome was chronic opioid use. Generalized linear models and finite mixture models were employed in analysis.
1789 Medicaid pediatric patients underwent appendectomy and met inclusion criteria. The mean age was 11.1 years and 40.6% were female. Most patients (94.6%) did not receive opioids prior to surgery. Opioid prescribing ≥90 days after surgery (chronic opioid use) occurred in 127 (7.1%) patients, of which 102 (80.3%) had no opioid use in the preexposure period. Risk factors for chronic opioid use included non-naïve opioid status, re-hospitalization more than 30 days following surgery, multiple opioid prescribers, age, and multiple antidepressants/antipsychotic prescriptions. Group-based trajectory analysis demonstrated four distinct post-surgical opioid use patterns: no opioid use (91.3%), later use (6.7%), slow wean (1.9%), and higher use throughout (0.4%).
Opioid exposure after appendectomy may serve as a priming event for persistent opioid use in some children. Eighty percent of children who developed post-surgical persistent opioid use had not received opioids in the 90 days leading up to surgery. Several mutable and immutable factors were identified to target future efforts toward opioid minimization in this at-risk patient population.
III.
在过去的 5 年中，全国上下齐心协力，缓解我国阿片类药物滥用不断上升的趋势。手术程序通常是儿童首次接触阿片类药物的途径，但接触后的使用轨迹尚不清楚。我们假设阑尾切除术的阿片类药物暴露会增加公共保险儿童持续使用阿片类药物的风险。
本研究是一项回顾性纵向队列研究，以 2014 年 1 月至 2017 年 12 月期间在南卡罗来纳州医疗补助计划中接受阑尾切除术的患者为研究对象，使用行政索赔数据。主要结局是慢性阿片类药物使用。在分析中使用了广义线性模型和有限混合模型。
共有 1789 名接受阑尾切除术且符合纳入标准的医疗补助计划儿科患者。平均年龄为 11.1 岁，其中 40.6%为女性。大多数患者（94.6%）在手术前没有使用过阿片类药物。手术后 90 天以上开具（慢性阿片类药物使用）阿片类药物处方的患者有 127 例（7.1%），其中 102 例（80.3%）在暴露前阶段没有使用过阿片类药物。慢性阿片类药物使用的风险因素包括非阿片类药物初次使用状态、手术后 30 天以上再次住院、有多个阿片类药物处方医生、年龄以及有多个抗抑郁药/抗精神病药物处方。基于群组的轨迹分析显示，术后有四种不同的阿片类药物使用模式：无阿片类药物使用（91.3%）、后期使用（6.7%）、缓慢减药（1.9%）和持续高剂量使用（0.4%）。
阑尾切除术后的阿片类药物暴露可能成为某些儿童持续使用阿片类药物的启动事件。80%发生术后持续使用阿片类药物的儿童在手术前的 90 天内没有使用过阿片类药物。确定了一些可改变和不可改变的因素，以便针对这一高危人群未来减少阿片类药物的使用。
III 级。
