Perioperative Opioid Exposure Patterns in Pediatric Anterior Cruciate Ligament Reconstruction: A Ten-Year
Dharman Anandarajan1, Brendan A Williams1, Nathan D Markiewitz1
1Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, USA.
Insights
Perioperative opioid exposure in pediatric anterior cruciate ligament reconstruction is common, affecting 88% of patients. Factors like age, gender, insurance, and hospital setting influence exposure, which has not declined and varies significantly between facilities.
Area of Science:
- Pediatric Orthopedics
- Pain Management
- Health Services Research
Background:
- Perioperative opioid exposure is a growing concern in pediatric surgery.
- Limited data exists on national trends in opioid use for pediatric anterior cruciate ligament reconstruction.
- Understanding demographic and hospital-level factors influencing exposure is crucial.
Purpose of the Study:
- To analyze national trends in perioperative opioid exposure for pediatric anterior cruciate ligament reconstruction.
- To identify demographic factors associated with opioid administration and exposure levels.
- To assess hospital-level variations in opioid utilization.
Main Methods:
- Utilized the Pediatric Health Information Systems Database (PHIS) from 2008-2017.
- Included 19,821 pediatric patients (≤ 18 years) undergoing anterior cruciate ligament reconstruction.
- Employed a hurdle generalized additive model to analyze opioid administration and relative opioid exposure (ROE).
Main Results:
- 88% of patients received perioperative opioids, with no significant temporal trend observed.
- Inpatient or observation settings, and female gender were associated with lower opioid administration likelihood.
- Commercial insurance correlated with higher relative opioid exposure; age and hospital trends were predictive.
Conclusions:
- Demographics (gender, age), surgical setting, hospital type, and insurance status significantly predict perioperative opioid exposure in pediatric ACL reconstruction.
- Opioid exposure rates have remained stable and show considerable inter-hospital variability.
- Further research is needed to explore the drivers of this variability and optimize opioid utilization.
Introduction:
Variation in opioid exposure has been documented in many pediatric fields; however, little is currently known about the extent of these findings during the perioperative period. The purpose of this study was to examine perioperative opioid exposure on a national level among patients undergoing anterior cruciate ligament (ACL) reconstruction using an administrative database. Our aims were to assess the impact of hospitals and a variety of demographic factors on (1) the likelihood of perioperative opioid exposure and (2) the variability in relative opioid exposure.
Methods:
The Pediatric Health Information Systems Database (PHIS) was used to identify pediatric patients (≤ 18 years old) across 52 hospitals undergoing ACL reconstruction between January 2008 and December 2017. Administered opioids in morphine milligram equivalents were discretized into quintiles to represent relative opioid exposure (ROE). A hurdle generalized additive model was estimated to identify demographic factors predictive of (1) the receipt of any opioid medication and (2) the ROE among those receiving opioids.
Results:
Of the 19,821 patients meeting study inclusion criteria, 17,350 (88%) were administered opioid medications perioperatively. There was no temporal trend in perioperative opioid utilization or ROE over the study period. Patients in an inpatient (OR = 0.260 [0.221, 0.305]) or observation unit (OR = 0.349 [0.305, 0.401]) context were less likely to be administered opioids. Female patients (OR = 0.896 [0.813, 0.987]) were less likely to be administered opioids, while patients on commercial insurance had a higher ROE (OR = 1.09 [1.023, 1.161]). Patient age and hospital-level time trends predicted opioid administration and exposure (max p < 0.001).
Discussion:
Gender, age, surgical setting, hospital type, and insurance status, in part, predicted perioperative opioid exposure among pediatric patients undergoing ACL reconstruction surgery. Exposure has not declined in recent years and varies significantly between hospitals. Although this study primarily served to document demographic variability in perioperative opioid exposure in pediatric patients undergoing ACL reconstruction, the understanding of variability in perioperative opioid utilization and exposure rate could stand to be further explored.
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