Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
Laryngoscope. 2023 Aug;133(8):1987-1992. doi: 10.1002/lary.30379. Epub 2022 Sep 2.
Postoperative opioid prescriptions tend to exceed children's analgesic needs, but awareness of the opioid epidemic may have driven changes in prescribing behaviors. This study evaluated opioid prescribing patterns after major pediatric ear surgery.
This study reviewed all cases of tympanoplasty, tympanomastoidectomy, mastoidectomy, cochlear implantation, otoplasty, and aural atresia repair at a pediatric hospital during 2010-2021. Regressions were conducted to identify opioid prescribing trends over time. Potential covariates were assessed. Returns to the system were reviewed as a balancing measure.
Even without a targeted protocol, opioid prescribing declined significantly. After prescribing peaked in 2012-2013, significant negative trends yielded lower rates of opioid prescriptions, fewer doses per prescription, smaller patient-weight-standardized dose sizes, and less variability (all p < 0.001). In 2012, 96.1% of patients received opioid prescriptions; the rate fell to 13.5% by 2021. For patients ages, 0-6, the annual rate of opioid prescriptions dropped from a maximum of 96.3% in 2012 to 0.0% in 2021. The annual average supply of doses per prescription decreased by 68% between 2013 and 2021, reducing the total days' supply to an evidence-based 3.1 ± 1.6 days. Regressions did not detect changes in returns to the system. Pain-related returns were rare (0.9%) and did not vary by opioid prescriptions (p = 0.37). Prescribing trends were closely correlated with a tonsillectomy-focused protocol that our institution implemented in 2019.
Surgeon-driven opioid stewardship has improved with no resultant change in revisit rates. Procedure-specific quality improvement interventions may have broader off-target effects on prescribing behaviors.
IV Laryngoscope, 133:1987-1992, 2023.
术后阿片类药物处方往往超过儿童的镇痛需求，但对阿片类药物流行的认识可能推动了处方行为的改变。本研究评估了小儿耳部手术后阿片类药物的处方模式。
本研究回顾了 2010 年至 2021 年期间一家儿童医院的鼓膜成形术、乳突切除术、乳突切除术、耳蜗植入术、耳成形术和耳闭锁修复术的所有病例。进行回归分析以确定随时间推移的阿片类药物处方趋势。评估了潜在的协变量。作为平衡措施，审查了系统的回报。
即使没有特定的方案，阿片类药物的处方也明显减少。在 2012-2013 年达到峰值后，显著的负趋势导致阿片类药物处方率、每张处方的剂量、按患者体重标准化的剂量大小和变异性降低（均 P < 0.001）。2012 年，96.1%的患者接受了阿片类药物处方；到 2021 年，该比例降至 13.5%。对于 0-6 岁的患者，阿片类药物处方的年度比例从 2012 年的最高 96.3%降至 2021 年的 0.0%。每张处方的平均年度剂量供应减少了 68%，从 2013 年到 2021 年，总供应天数减少到基于证据的 3.1±1.6 天。回归分析未发现系统回报的变化。与疼痛相关的回报很少（0.9%），与阿片类药物处方无关（p=0.37）。处方趋势与我们机构在 2019 年实施的扁桃体切除术为重点的方案密切相关。
在没有导致就诊率变化的情况下，外科医生驱动的阿片类药物管理得到了改善。特定于手术的质量改进干预措施可能对处方行为产生更广泛的非目标影响。
IV 喉镜，133：1987-1992，2023。
