The Cost of Opioid Use in High-Risk Hospitalized Infants.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Updates From the Other Side of the Drape: Recent Advances in Multimodal Pain Management and Opioid Reduction Among Pediatric Surgical Patients.

As the management of acute pain for children undergoing surgical procedures as well as recognition of the short and long term risks of exposure to opioids has evolved, multimodal and multidisciplinary approaches using organized pathways has resulted in improved perioperative outcomes and patient satisfaction. In this 2023 symposium held at the American Academy of Pediatrics on Surgery meeting, a multidisciplinary discussion on current enhanced recovery after surgery pathways, alternate methods of effective pain control and education and advocacy efforts for opioid reduction were discussed, and highlights are included in this article.

The use of a primary care provider survey to implement a fall prevention program in an urban hospital system.

BACKGROUND: Falls are the leading cause of traumatic injury in older adults. Multidisciplinary approaches between trauma surgeons and primary care providers can powerfully advocate for fall prevention. This study explores current fall prevention practices and barriers to falls screening and prevention in the primary care setting and proposes pertinent recommendations to address the deficiencies. METHODS: A questionnaire was adapted from a previous survey study to explore the beliefs, knowledge, attitudes, and clinical practice regarding falls by primary care providers. The questionnaire was distributed by e-mail to primary care providers at a tertiary urban medical center. RESULTS: The survey achieved a response rate of 58%. All respondents agreed that older adult patients should be assessed for fall risks and that evidence-based fall prevention programs can reduce the risk of falls. However, 43% of respondents did not agree that they had the expertise to perform fall risk assessments, and similarly 43% did not agree they have the time to perform fall risk assessments in the office. Furthermore, although 52% of respondents were aware of the Medicare reimbursement for fall risk screening, only 24% had billed for fall risk screening and only 5% agreed that they were adequately reimbursed. CONCLUSION: Several barriers to performing fall prevention care in the primary care setting were identified: unfamiliarity with resources, perceived lack of time, and perceived insufficient reimbursement. We implemented a set of interventions which include an educational series and workflow optimization to overcome barriers identified.