Provider education decreases opioid prescribing after pediatric umbilical hernia repair
Provider education decreases opioid prescribing after pediatric umbilical hernia repair
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DOI：
10.1016/j.jpedsurg.2019.04.035
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发表时间：
2020-07-01
影响因子：
2.4
通讯作者：
Raval, Mehul V.
中科院分区：
文献类型：
--
作者：
Piper, Kaitlin N.;Baxter, Katherine J.;Raval, Mehul V.
目的：为了提高阿片类药物管理的脐疝repairinchild.Methods：教育干预进行了9个中心与79名外科医生的干预强调了阿片类药物管理的重要性，证明实践的变化，提供处方指南，鼓励非阿片类镇痛药，并鼓励限制剂量/强度，如果阿片类药物处方。干预前3至6个月和干预后3个月的处方做法为脐疝repairs.Results：共确定了343例患者在干预前队列和346在干预后队列。出院时接受阿片类药物治疗的患者比例从干预前的75.8%下降到干预后的44.6%（p < 0.001）。在调整年龄、性别、脐成形术和医院地点后，干预后与干预前阿片类药物处方的比值比为0.27（95% CI = 0.18-0.39，p < 0.001）。在接受阿片类药物治疗的患者中，干预后处方的关闭次数减少（校正均值为14.3至10.4，p < 0.001）。然而，吗啡当量/kg/剂量未显著降低（校正平均值0.14 - 0.13，p = 0.20）。有没有差异，在返回到急诊室或再入院之间的前和后干预cohorts.Conclusions：阿片类药物的管理，可以改善后，儿科脐herrna修复使用低保真度的教育intervention.Type的研究：回顾性队列研究。(C)2019爱思唯尔公司All rights reserved.
Purpose: To improve opioid stewardship for umbilical hernia repair in children.Methods: An educational intervention was conducted at 9 centers with 79 surgeons The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared.Results: A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001) post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post-versus the pre-intervention period was 0.27 (95% CI = 0.18-0.39, p < 0.001). Among patients receiving opioicls, the number of closes prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post -intervention cohorts.Conclusions: Opioid stewardship can be improved after pediatric umbilical herrna repair using a low-fidelity educational intervention.Type of Study: Retrospective cohort study. (C) 2019 Elsevier Inc. All rights reserved.