From the Department of Pediatric Emergency Medicine, Nicklaus Children's Hospital, Miami, FL.
Department of Pediatric Emergency Medicine, Connecticut Children's, University of Connecticut School of Medicine, Hartford, CT.
Pediatr Emerg Care. 2024 Jan 1;40(1):38-44. doi: 10.1097/PEC.0000000000002926. Epub 2023 Mar 28.
This study aimed to determine the association between opioid prescriptions given after tonsillectomy with adenoidectomy (T + A) and pain-related return visit rates in pediatric patients. Determine association between Food and Drug Administration (FDA) black box warning against opioid use in this population and pain-related return visit rates.
This was a single-institution retrospective cohort study of pediatric patients who underwent T + A between April 2012 and December 2015 and had return visits to the emergency department or urgent care center. Data were obtained from the hospital electronic warehouse using International Classification of Diseases-9/10 procedure codes. Odds ratios (ORs) with 95% confidence intervals (CIs) for return visits were calculated. Multivariate logistic regression analysis was used to measure association between opioid prescriptions and return visit rates as well as FDA warning and return visit rates adjusting for confounders.
There were 4778 patients who underwent T + A, median age, 5 years. Of these, 752 (15.7%) had return visits. Pain-related return visits were higher in patients who received opioid prescriptions (adjusted OR, 1.31; 95% CI, 1.09-1.57). After FDA warning, opioids were prescribed at a lower rate (47.9%) compared with previous (98.6%) (OR, 0.01; 95% CI, 0.008-0.02). Pain-related return visits were lower after FDA warning (OR, 0.73; 95% CI, 0.61-0.87). Steroid prescription rate increased after FDA warning (OR, 415; 95% CI, 197-874).
Opioid prescriptions were associated with higher pain-related return visits after T + A, whereas issuance of FDA black box warning against codeine use was associated with lower pain-related return visits. Our data suggest that the black box warning potentially had unintended benefits in pain management and health care usage.
本研究旨在确定扁桃体腺样体切除术（T+A）后开具阿片类药物处方与儿科患者疼痛相关复诊率之间的关联。确定食品和药物管理局（FDA）针对该人群使用阿片类药物的黑框警告与疼痛相关复诊率之间的关联。
这是一项单机构回顾性队列研究，纳入 2012 年 4 月至 2015 年 12 月期间接受 T+A 的儿科患者，并在急诊室或紧急护理中心进行复诊。使用国际疾病分类第 9 版/第 10 版手术代码从医院电子仓库中获取数据。使用多变量逻辑回归分析来衡量阿片类药物处方与复诊率之间的关联，以及 FDA 警告与调整混杂因素后的复诊率之间的关联。
共有 4778 名患者接受了 T+A，中位年龄为 5 岁。其中 752 例（15.7%）有复诊。接受阿片类药物处方的患者疼痛相关复诊率更高（调整后的比值比，1.31；95%置信区间，1.09-1.57）。在 FDA 警告后，阿片类药物的开具率较低（47.9%），而之前的开具率为 98.6%（比值比，0.01；95%置信区间，0.008-0.02）。在 FDA 警告后，疼痛相关复诊率较低（比值比，0.73；95%置信区间，0.61-0.87）。在 FDA 警告后，皮质类固醇的开具率增加（比值比，415；95%置信区间，197-874）。
T+A 后开具阿片类药物处方与疼痛相关复诊率较高相关，而 FDA 发布针对可待因使用的黑框警告与疼痛相关复诊率较低相关。我们的数据表明，黑框警告在疼痛管理和医疗保健使用方面可能具有意外的益处。
