Smith Cavalcante Julia, Kunisawa Susumu, Fushimi Kiyohide, Kato Karin, Imanaka Yuichi
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
J Anesth. 2025 Jun 14. doi: 10.1007/s00540-025-03525-7.
To evaluate the use of opioid analgesics for postoperative pain management in pediatric appendectomy patients in Japan, investigating individual and facility-related factors using hospital administrative data.
This study was a retrospective cohort study. Data was sourced from the Diagnosis Procedure Combination database. Inclusion criteria were: patients 2-18 years old; admitted and discharged between April 1st, 2018 and March 31, 2020; diagnosed with acute appendicitis; and who underwent appendectomy. The outcome was postoperative opioid use, calculated as the proportion of patients who used opioid from the day after surgery.
There were 11,346 cases that were selected for the study. The overall proportion of patients who were administered postoperative opioids (POAP) was 9.47%. The POAP was similar across ages, sexes and types of surgery, but higher for patients with longer length of stay (LOS) and patients with abscess. The group that was administered opioids preoperatively had higher POAP. Inter-hospital variation was observed, as less than 40% of the hospitals were responsible for all patients who used postoperative opioids. Opioids were prescribed upon discharge to 0.01% patients.
The POAP in pediatric appendectomy patients in Japan was lower than that observed in other countries, which might be attributed to legislation and opioid prescription culture. Hospital variation was observed, which might be related to the lack of guidelines and evidence-based recommendations, and to physician and hospital preferences. Future research is necessary for the development of guidelines that detail the appropriate use of opioids and avoid unnecessary exposure to pediatric patients.
利用医院管理数据，评估日本小儿阑尾炎切除术患者术后使用阿片类镇痛药进行疼痛管理的情况，并调查个体及机构相关因素。
本研究为回顾性队列研究。数据来源于诊断程序组合数据库。纳入标准为：年龄2至18岁；在2018年4月1日至2020年3月31日期间入院及出院；诊断为急性阑尾炎；且接受了阑尾切除术。观察指标为术后阿片类药物的使用情况，计算方法为术后次日使用阿片类药物的患者比例。
共选取11346例病例进行研究。术后接受阿片类药物治疗（POAP）的患者总体比例为9.47%。POAP在不同年龄、性别和手术类型中相似，但住院时间较长的患者和有脓肿的患者比例更高。术前接受阿片类药物治疗的组POAP更高。观察到医院间存在差异，不到40%的医院负责所有术后使用阿片类药物的患者。出院时给0.01%的患者开具了阿片类药物。
日本小儿阑尾炎切除术患者的POAP低于其他国家观察到的水平，这可能归因于立法和阿片类药物处方文化。观察到医院间存在差异，这可能与缺乏指南和循证建议以及医生和医院的偏好有关。未来有必要开展研究以制定详细说明阿片类药物合理使用并避免小儿患者不必要暴露的指南。
