Safety Assessment of Perioperative Pain Medications for Children (SAPPhire)

项目摘要 美国的人均阿片类药物处方比其他任何国家都高，阿片类药物危机不会影响到 只有成年人，但也有儿童和青少年。尽管与阿片类药物有关的儿科住院人数增加 中毒和与阿片类药物相关的重症监护病房入院，然而，儿童中阿片类药物的使用还没有得到充分的研究 被低估了。考虑到吸毒损害儿童大脑的发育和使用，研究中的这一差距令人担忧 在儿童/青春期早期使用处方阿片类药物是滥用处方阿片类药物的一个风险因素。一 儿童滥用阿片类药物的途径始于疼痛控制手术后的暴露和200多万 在美国，儿童每年都要接受手术。证据还表明，儿科外科医生经常开出 小程序后超过必要的阿片类药物，超过50%的处方药剩余 未使用，并导致过量的阿片类药物储存在有儿童的家庭中，因此可供 非医疗用途。 目前，还没有全面的数据来源对儿科手术围手术期疼痛进行分类。 管理做法，包括开止痛药和评估疼痛控制，两者都 为儿科手术围手术期疼痛制定循证建议是必要的 管理层。这个项目，儿童围术期止痛药的安全评估(Sapphire)，将 创建这个独特的数据源来研究、了解和改善当前的儿科手术围手术期疼痛 管理，通过结合关于当前疼痛管理做法的数据(例如，局部麻醉药、区域麻醉药、 神经阻滞、非阿片类镇痛剂和儿科专用阿片类药物处方实践)，患者级别 人口统计、健康状况(例如，合并症、手术)和结果(例如，住院时间、 手术部位感染和再入院)数据来自美国外科医师学会(ACS)国家外科 质量改进计划-儿科(NSQIP-P)。此外，出院后阿片类药物的使用和患者报告 将收集有关疼痛控制和日常活动限制的结果(PRO)。综合起来，这些数据将 指导反馈和干预以解决外科医生和医院层面的疼痛管理实践差异 并确定儿科手术患者的高“阿片类药物使用”程序和高“阿片类药物暴露”亚组。 这项研究还将评估对FDA阿片类药物禁忌症和警告的遵守情况。这是形成性的 这项研究将提供制定儿科程序和患者特定指南所需的基本信息 止痛药。从蓝宝石学到的经验教训将有助于更广泛地采用围手术期疼痛 管理实践遍及全美150家NSQIP-P医院。

PROJECT ABSTRACT Per capita opioid prescribing is higher in the US than in any other nation and the opioid crisis affects not only adults, but, also children and adolescents. Despite increases in pediatric hospitalizations related to opioid poisonings and opioid-related critical care unit admissions, yet, opioid use in children is understudied and underestimated. This gap in research is alarming given that drug use impairs child brain development and use of prescription opioids during childhood/early adolescence is a risk factor for prescription opioid misuse. One path to childhood opioid misuse begins with exposure after surgery for pain control and more than 2 million children undergo surgery in the US each year. Evidence also suggests that pediatric surgeons often prescribe more opioids than necessary following minor procedures with more than 50% of prescribed pills remaining unused, and resulting in excess opioids being stored in homes with children and, thus, becoming accessible for nonmedical use. Currently, no comprehensive data source exists that catalogues pediatric surgery perioperative pain management practices, including pain medication prescribing and that also assesses pain control, both of which are necessary to develop evidence-based recommendations for pediatric surgery perioperative pain management. This project, Safety Assessment of Perioperative Pain Medications for Children (SAPPhire),will create this unique data source to study, understand, and improve current pediatric surgery perioperative pain management, by combining data about current pain management practices (e.g., local anesthetics, regional nerve blocks, non-opioid analgesics, and pediatric-specific opioid prescribing practices), with patient-level demographic, health (e.g., comorbid conditions, surgical procedure), and outcomes (e.g., length of stay, surgical-site infections, and readmission) data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P). In addition, post-discharge opioid use and patient reported outcomes (PROs) on pain control and limitations of daily activities will be collected. Combined, these data will guide feedback and interventions to address surgeon- and hospital-level pain management practice variation and identify high “opioid-use” procedures and high “opioid-exposed” subgroups of pediatric surgical patients. The study will also assess adherence to FDA opioid medication contraindications and warnings. This formative study will provide essential information needed to develop pediatric procedure- and patient-specific guidelines for pain management. Lessons learned from SAPPhire will facilitate wider adoption of perioperative pain management practices across to the >150 NSQIP-P hospitals across the United States.