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Opioid consumption before discharge predicts outpatient opioid use in adolescents undergoing surgery.
Chen, Stephanie Y; Ourshalimian, Shadassa; Hijaz, Donia; Odegard, Marjorie N; Kim, Eugene; Andras, Lindsay; Kelley-Quon, Lorraine I.
Afiliação
  • Chen SY; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA. Electronic address: https://twitter.com/steph_y_chen.
  • Ourshalimian S; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
  • Hijaz D; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
  • Odegard MN; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA. Electronic address: https://twitter.com/MarjorieOdegard.
  • Kim E; Division of Pain Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
  • Andras L; Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
  • Kelley-Quon LI; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery & Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: LKQuon@chla.usc.edu.
Surgery ; 176(2): 462-468, 2024 Aug.
Article em En | MEDLINE | ID: mdl-38763792
ABSTRACT

BACKGROUND:

The majority of adolescents undergoing surgery report unused prescription opioids after surgery, increasing the risk of diversion, misuse, and addiction. Adult studies have demonstrated that opioid use 24 hours before discharge corresponds with opioid use at home. We hypothesized that inpatient opioid consumption is associated with outpatient opioid use in adolescents.

METHODS:

Adolescents aged 13-20 years undergoing elective surgery associated with an opioid prescription were prospectively recruited. Parent-adolescent dyads were surveyed preoperatively to assess sociodemographics, health literacy, and baseline substance use, and opioid use was measured at 30- and 90-days postoperatively. Medical records were reviewed to calculate cumulative opioid use during hospitalization. Inpatient and postoperative opioid use was converted to oral morphine equivalents. Adjusting for age, sex, race, health literacy, alcohol use, pain score, and surgery, multivariable linear regression identified factors associated with outpatient oral morphine equivalent use 90 days postoperatively.

RESULTS:

Overall, 103 adolescents were enrolled. Median oral morphine equivalents used from 24 and 48 hours before discharge and throughout the hospitalization were 30.8 (interquartile range11.7-45.0), 67.5 (interquartile range37.5-94.3), and 97.5 (interquartile range18.0-152.7), respectively. Regression analysis demonstrated that adolescent-reported pain at discharge (P = .028) and cumulative oral morphine equivalents used 24 hours (P < .001) and 48 hours (P = .003) before discharge were significantly associated with postoperative oral morphine equivalents use at home. Oral morphine equivalents consumption 24 hours before discharge estimated cumulative oral morphine equivalents use 90 days postoperatively at a 1-to-5 ratio in 94.1% of patients.

CONCLUSION:

For adolescents undergoing surgery, patient-reported pain at discharge and oral morphine equivalents administered 24 hours before discharge are associated with cumulative outpatient opioid use. Tailoring outpatient prescriptions to total oral morphine equivalent consumption 24 hours before discharge could reduce excess opioid prescribing.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dor Pós-Operatória / Alta do Paciente / Analgésicos Opioides Limite: Adolescent / Adult / Female / Humans / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dor Pós-Operatória / Alta do Paciente / Analgésicos Opioides Limite: Adolescent / Adult / Female / Humans / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article