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The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy

Cory McLaughlin1, Anthony I Squillaro1, Shadassa Ourshaliman1

  • 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.

Clinical Therapeutics
|August 15, 2019
PubMed

Insights

Opioid use varies widely in infants after pyloromyotomy. Postoperative opioid administration is linked to longer hospital stays, suggesting nonopioid pain management may be beneficial.

Area of Science:

  • Pediatric Surgery
  • Pain Management
  • Health Services Research

Background:

  • Opioid use in infants undergoing pyloromyotomy is not well-characterized.
  • Understanding national variations in opioid prescribing is crucial for optimizing patient care.

Purpose of the Study:

  • To describe the frequency and variation of opioid administration in infants undergoing pyloromyotomy.
  • To determine the impact of opioid use on postoperative outcomes such as length of stay and readmission.

Main Methods:

  • Retrospective cohort study using the Pediatric Health Information System (PHIS) database (2005-2015).
  • Included infants (<6 months) with pyloric stenosis undergoing pyloromyotomy, excluding those with significant comorbidities.
  • Opioid use categorized as preoperative, day of surgery, or postoperative; outcomes included prolonged hospital length of stay (LOS) and 30-day readmission.

Main Results:

  • Analyzed 25,724 infants; 26.7% received opioids, with 5.4% receiving them postoperatively.
  • Significant hospital variation in opioid use frequency (0%-81%) observed in 2015.
  • Postoperative opioid use was associated with increased odds of prolonged hospital LOS (OR, 1.71), while day-of-surgery use alone showed decreased odds (OR, 0.85).

Conclusions:

  • Significant national variability exists in opioid use for infants undergoing pyloromyotomy.
  • Postoperative opioid administration is associated with prolonged hospital stay.
  • Nonopioid analgesic protocols warrant further investigation for this patient population.
Abstract

Keywords:
infantopioidpyloric stenosispyloromyotomy

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