A Societies for Pediatric Urology survey of opioid prescribing practices after ambulatory pediatric urology procedures
A Societies for Pediatric Urology survey of opioid prescribing practices after ambulatory pediatric urology procedures
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DOI：
10.1016/j.jpurol.2019.04.025
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发表时间：
2019-10-01
影响因子：
2
通讯作者：
Merguerian, P. A.
中科院分区：
文献类型：
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作者：
Ahn, J. J.;Ellison, J. S.;Merguerian, P. A.
阿片类药物依赖和滥用已被宣布为国家突发公共卫生事件，手术后阿片类药物的过量处方已被确定为一个驱动因素。迄今为止，儿科泌尿外科门诊手术后的阿片类药物处方尚未得到很好的描述。目的：本研究的目的是评估儿科泌尿科医生在常规门诊手术中处方阿片类药物的做法。研究设计创建了一项包含23个问题的调查，包括8个病例，描述了三个年龄组（8个月、3岁、13岁）的常规手术（睾丸切除术、鞘膜积液修复、包皮环切）。多项选择题询问每个病例的典型阿片类药物类型和持续时间。受访者的态度和做法类型也进行了评估。这项调查是通过儿科泌尿外科学会进行的。在102名应答者中，48%的人报告了所有病例的术后阿片类药物处方（图1）。14%的人报告在所有病例中都没有开阿片类药物处方。处方持续时间越长，年龄越大（p = 0.003）。对乙酰氨基酚-氢可酮是最常见的处方，而少数受访者报告处方对乙酰氨基酚-可待因。中北部和东南部受访者更有可能为所有描述的病例开阿片类药物（p = 0.003）。大多数受访者在学术环境中工作，有10年以上的实践经验。只有16%的人认为他们的病人服用了处方中的大部分阿片类药物，而只有35%的人向他们的病人提供了有关正确处置阿片类药物的教育。在儿科泌尿科医生的门诊手术后，报告的阿片类药物处方实践存在显著差异。只有16%的答复者认为患者服用了处方的大部分阿片类药物，只有14%的答复者报告从未在这些手术中开过阿片类药物。有机会指导和标准化护理的术后镇痛在这一患者群体。鉴于过量处方可能导致滥用和误用，需要进一步开展工作，以确定术后镇痛需求，并教育提供者和家庭如何正确开处方和处置。结论：儿科泌尿科医生报告说，尽管认为大多数患者没有服用处方药物，但婴儿、儿童和青少年在常规门诊手术后经常开阿片类药物。
IntroductionOpioid dependence and abuse has been declared a national public health emergency, and over-prescribing of opioids after surgery has been identified as a driving factor. To date, opioid prescribing after pediatric urology ambulatory surgery has not been well-described.ObjectiveThe study's objective was to assess pediatric urologists' practices in prescribing opioids for routine ambulatory procedures.Study designA 23-question survey was created, including eight case vignettes describing routine procedures (orchiopexy, hydrocele repair, circumcision) across three age groups (8 months, 3 years, 13 years). Multiple choice questions asked about typical opioid type and duration for each case. Respondent attitudes and practice types were also evaluated. The survey was administered through the Societies for Pediatric Urology.ResultsOf the 102 respondents, 48% reported prescribing postoperative opioids for all cases described (Figure 1). Fourteen percent reported prescribing no opioids for all cases. Longer prescription duration was associated with older age (p = 0.003). Acetaminophen-hydrocodone was prescribed most commonly, while a few respondents reported prescribing acetaminophen-codeine. North Central and Southeastern respondents were more likely to prescribe opioids for all cases described (p = 0.003). The majority of respondents work in academic settings and had >10 years in practice. Only 16% believe that their patients take the majority of opioids prescribed, while only 35% provide education to their patients on proper disposal.DiscussionThere is significant variability in reported opioid prescribing practices after ambulatory procedures amongst pediatric urologists. Only 16% of respondents believe that patients take the majority of opioids prescribed, and only 14% reported never prescribing opioids for these procedures. There is an opportunity for guidelines and standardization of care for postoperative analgesia in this patient population. Given that overprescribing can lead to abuse and misuse, further work needs to be done to establish postoperative analgesia needs and to educate providers and families on proper prescribing and disposal.ConclusionPediatric urologists report prescribing opioids frequently after routine ambulatory procedures in infants, children, and adolescents despite believing that patients do not take the majority of the prescribed medication.