Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
J Surg Res. 2024 Oct;302:825-835. doi: 10.1016/j.jss.2024.07.028. Epub 2024 Sep 5.
Hospitalizations of high-risk infants are among the most expensive in the United States, with many requiring surgery and months of intensive care. Healthcare costs and resource use associated with hospitalized infant opioid exposure are less well known.
A retrospective cohort of high-risk infants aged <1 y admitted from 47 children's hospitals from 2010 to 2020 was identified from Pediatric Healthcare Information System. High-risk infants were identified by International Classification of Diseases 9/10 codes for congenital heart disease procedures, medical and surgical necrotizing enterocolitis, extremely low birth weight, very low birth weight, hypoxemic ischemic encephalopathy, extracorporeal membrane oxygenation, and gastrointestinal tract malformations. Healthcare resource utilization was estimated using standardized unit costs (SUCs). The impact of opioid use on SUC was examined using general linear models and an instrumental variable.
Overall, 126,897 high-risk infants were identified. The cohort was majority White (57.1%), non-Hispanic (72.0%), and male (55.4%). Prematurity occurred in 26.4% and a majority underwent surgery (77.9%). Median SUC was $120,585 (interquartile range: $57,602-$276,562) per infant. On instrumental variable analysis, each day of opioid use was associated with an increase of $4406 in SUC. When adjusting for biologic sex, race, ethnicity, insurance type, diagnosis category, number of comorbidities, mechanical ventilation, and total parental nutrition use, each day of opioid use was associated with an increase of $2177 per infant.
Prolonged opioid use is significantly associated with healthcare utilization and costs for high-risk infants, even when accounting for comorbidities, intensive care, ventilation, and total parental nutrition use. Future studies are needed to estimate the long-term complications and additional costs resulting from prolonged opioid exposures in high-risk infants.
在美国，高危婴儿的住院治疗费用是最高的，其中许多婴儿需要手术和数月的重症监护。然而，与住院婴儿阿片类药物暴露相关的医疗保健成本和资源使用情况则知之甚少。
本研究通过回顾性分析，从 2010 年至 2020 年期间 47 家儿童医院的儿科医疗保健信息系统中，确定了 126897 名年龄<1 岁的高危婴儿。高危婴儿通过国际疾病分类第 9/10 版的先天性心脏病手术、医疗和外科坏死性小肠结肠炎、极低出生体重、极低出生体重、缺氧缺血性脑病、体外膜氧合和胃肠道畸形的编码来识别。医疗资源利用情况采用标准化单位成本（SUC）进行估计。采用一般线性模型和工具变量法来研究阿片类药物使用对 SUC 的影响。
研究共纳入 126897 名高危婴儿，其中 57.1%为白人，72.0%为非西班牙裔，55.4%为男性。26.4%的婴儿早产，大多数（77.9%）接受了手术。每名婴儿的平均 SUC 为 120585 美元（中位数：57602-276562 美元）。在工具变量分析中，阿片类药物使用的每一天都与 SUC 增加 4406 美元相关。在调整了生物学性别、种族、民族、保险类型、诊断类别、合并症数量、机械通气和全胃肠外营养使用后，阿片类药物使用的每一天与 SUC 增加 2177 美元相关。
即使考虑到合并症、重症监护、通气和全胃肠外营养的使用，高危婴儿中阿片类药物的长期使用与医疗保健的利用和成本显著相关。需要进一步的研究来评估高危婴儿中阿片类药物暴露的长期并发症和额外成本。
