Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA. Electronic address: https://twitter.com/steph_y_chen.
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Surgery. 2024 Aug;176(2):462-468. doi: 10.1016/j.surg.2024.03.041. Epub 2024 May 19.
The majority of adolescents undergoing surgery report unused prescription opioids after surgery, increasing the risk of diversion, misuse, and addiction. Adult studies have demonstrated that opioid use 24 hours before discharge corresponds with opioid use at home. We hypothesized that inpatient opioid consumption is associated with outpatient opioid use in adolescents.
Adolescents aged 13-20 years undergoing elective surgery associated with an opioid prescription were prospectively recruited. Parent-adolescent dyads were surveyed preoperatively to assess sociodemographics, health literacy, and baseline substance use, and opioid use was measured at 30- and 90-days postoperatively. Medical records were reviewed to calculate cumulative opioid use during hospitalization. Inpatient and postoperative opioid use was converted to oral morphine equivalents. Adjusting for age, sex, race, health literacy, alcohol use, pain score, and surgery, multivariable linear regression identified factors associated with outpatient oral morphine equivalent use 90 days postoperatively.
Overall, 103 adolescents were enrolled. Median oral morphine equivalents used from 24 and 48 hours before discharge and throughout the hospitalization were 30.8 (interquartile range:11.7-45.0), 67.5 (interquartile range:37.5-94.3), and 97.5 (interquartile range:18.0-152.7), respectively. Regression analysis demonstrated that adolescent-reported pain at discharge (P = .028) and cumulative oral morphine equivalents used 24 hours (P < .001) and 48 hours (P = .003) before discharge were significantly associated with postoperative oral morphine equivalents use at home. Oral morphine equivalents consumption 24 hours before discharge estimated cumulative oral morphine equivalents use 90 days postoperatively at a 1-to-5 ratio in 94.1% of patients.
For adolescents undergoing surgery, patient-reported pain at discharge and oral morphine equivalents administered 24 hours before discharge are associated with cumulative outpatient opioid use. Tailoring outpatient prescriptions to total oral morphine equivalent consumption 24 hours before discharge could reduce excess opioid prescribing.
大多数接受手术的青少年在手术后报告未使用处方类阿片，这增加了药物转移、滥用和成瘾的风险。成人研究表明，出院前 24 小时内使用阿片类药物与在家中使用阿片类药物有关。我们假设住院期间的阿片类药物消耗与青少年门诊期间的阿片类药物使用有关。
前瞻性招募了年龄在 13 至 20 岁之间接受与阿片类药物处方相关的择期手术的青少年。在手术前对父母-青少年二人组进行了调查，以评估社会人口统计学、健康素养和基线物质使用情况，并在手术后 30 天和 90 天进行了阿片类药物使用评估。回顾了医疗记录以计算住院期间的累计阿片类药物消耗。将住院和术后阿片类药物使用量转换为口服吗啡等效物。调整年龄、性别、种族、健康素养、酒精使用、疼痛评分和手术因素后，多变量线性回归确定了与术后 90 天门诊口服吗啡等效物使用相关的因素。
总体而言，共纳入了 103 名青少年。出院前 24 小时和 48 小时以及整个住院期间使用的口服吗啡等效物中位数分别为 30.8（四分位距：11.7-45.0）、67.5（四分位距：37.5-94.3）和 97.5（四分位距：18.0-152.7）。回归分析表明，青少年出院时报告的疼痛（P=0.028）以及出院前 24 小时（P<0.001）和 48 小时（P=0.003）累计口服吗啡等效物使用与术后家庭口服吗啡等效物使用显著相关。出院前 24 小时的口服吗啡等效物消耗可以在 94.1%的患者中以 1 比 5 的比例估计 90 天的累计门诊阿片类药物使用。
对于接受手术的青少年，出院时的患者报告疼痛和出院前 24 小时给予的口服吗啡等效物与累计门诊阿片类药物使用有关。根据出院前 24 小时的总口服吗啡等效物消耗调整门诊处方可以减少过量的阿片类药物处方。
