Amna Minhas, Humza Thobani, Arsalan Javid, Joyce McRae, Georgi Mladenov, Benjamin Farber, Andrei Radulescu, Faraz Khan, Steven L Raymond
{"title":"儿童阑尾切除术后阿片类药物出院处方：一项NSQIP-P研究。","authors":"Amna Minhas, Humza Thobani, Arsalan Javid, Joyce McRae, Georgi Mladenov, Benjamin Farber, Andrei Radulescu, Faraz Khan, Steven L Raymond","doi":"10.1016/j.jpedsurg.2025.162475","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate national trends in opioid prescriptions following discharge for appendectomy in children with appendicitis using the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) database. Furthermore, we aimed to analyze the association between opioid prescriptions at discharge and emergency department (ED) visits and readmissions in this patient cohort.</p><p><strong>Methods: </strong>The NSQIP-P database was queried for all patients under 18 years of age who underwent laparoscopic appendectomy for simple or complicated appendicitis. Patients were stratified based on whether they received an opioid prescription at discharge. Demographics, clinical characteristics and postoperative outcomes were compared between patients receiving opioid prescriptions versus those who did not. Multivariable logistic regression was used to identify predictors of opioid prescribing and its association with ED visits and unplanned readmissions.</p><p><strong>Results: </strong>Among 22,148 pediatric appendectomy patients, 5.2% received opioids at discharge. In patients with simple appendicitis, older age (p<0.001), male sex (p=0.027), Black/African American race (p=0.012), computed tomography (CT) without ultrasound (p<0.001) and decreased length of stay (p=0.002) were independent predictors of opioid prescription. In cases of complicated appendicitis, independent predictors of opioid prescription included older age (p=0.001), CT use without ultrasound (p<0.001) and shorter hospital stay (p<0.001). Discharge opioids were associated with increased odds of ED visits (aOR 1.28, 95% CI: 1.00-1.60), but not unplanned readmissions (aOR 1.13, CI 95%: 0.75-1.64).</p><p><strong>Conclusion: </strong>Despite declining national rates, variation in opioid prescribing following appendectomy persists. Poor radiation stewardship and patient demographics appear to be associated with prescribing patterns. Efforts to optimize pain management and reduce unnecessary opioid exposure are warranted.</p><p><strong>Type of study: </strong>Retrospective Comparative Study.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162475"},"PeriodicalIF":2.5000,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Discharge Opioid Prescriptions Following Pediatric Appendectomy: a NSQIP-P Study.\",\"authors\":\"Amna Minhas, Humza Thobani, Arsalan Javid, Joyce McRae, Georgi Mladenov, Benjamin Farber, Andrei Radulescu, Faraz Khan, Steven L Raymond\",\"doi\":\"10.1016/j.jpedsurg.2025.162475\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>This study aimed to evaluate national trends in opioid prescriptions following discharge for appendectomy in children with appendicitis using the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) database. Furthermore, we aimed to analyze the association between opioid prescriptions at discharge and emergency department (ED) visits and readmissions in this patient cohort.</p><p><strong>Methods: </strong>The NSQIP-P database was queried for all patients under 18 years of age who underwent laparoscopic appendectomy for simple or complicated appendicitis. Patients were stratified based on whether they received an opioid prescription at discharge. Demographics, clinical characteristics and postoperative outcomes were compared between patients receiving opioid prescriptions versus those who did not. Multivariable logistic regression was used to identify predictors of opioid prescribing and its association with ED visits and unplanned readmissions.</p><p><strong>Results: </strong>Among 22,148 pediatric appendectomy patients, 5.2% received opioids at discharge. In patients with simple appendicitis, older age (p<0.001), male sex (p=0.027), Black/African American race (p=0.012), computed tomography (CT) without ultrasound (p<0.001) and decreased length of stay (p=0.002) were independent predictors of opioid prescription. In cases of complicated appendicitis, independent predictors of opioid prescription included older age (p=0.001), CT use without ultrasound (p<0.001) and shorter hospital stay (p<0.001). Discharge opioids were associated with increased odds of ED visits (aOR 1.28, 95% CI: 1.00-1.60), but not unplanned readmissions (aOR 1.13, CI 95%: 0.75-1.64).</p><p><strong>Conclusion: </strong>Despite declining national rates, variation in opioid prescribing following appendectomy persists. Poor radiation stewardship and patient demographics appear to be associated with prescribing patterns. Efforts to optimize pain management and reduce unnecessary opioid exposure are warranted.</p><p><strong>Type of study: </strong>Retrospective Comparative Study.</p><p><strong>Level of evidence: </strong>III.</p>\",\"PeriodicalId\":16733,\"journal\":{\"name\":\"Journal of pediatric surgery\",\"volume\":\" \",\"pages\":\"162475\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-07-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of pediatric surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jpedsurg.2025.162475\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pediatric surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpedsurg.2025.162475","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Discharge Opioid Prescriptions Following Pediatric Appendectomy: a NSQIP-P Study.
Introduction: This study aimed to evaluate national trends in opioid prescriptions following discharge for appendectomy in children with appendicitis using the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) database. Furthermore, we aimed to analyze the association between opioid prescriptions at discharge and emergency department (ED) visits and readmissions in this patient cohort.
Methods: The NSQIP-P database was queried for all patients under 18 years of age who underwent laparoscopic appendectomy for simple or complicated appendicitis. Patients were stratified based on whether they received an opioid prescription at discharge. Demographics, clinical characteristics and postoperative outcomes were compared between patients receiving opioid prescriptions versus those who did not. Multivariable logistic regression was used to identify predictors of opioid prescribing and its association with ED visits and unplanned readmissions.
Results: Among 22,148 pediatric appendectomy patients, 5.2% received opioids at discharge. In patients with simple appendicitis, older age (p<0.001), male sex (p=0.027), Black/African American race (p=0.012), computed tomography (CT) without ultrasound (p<0.001) and decreased length of stay (p=0.002) were independent predictors of opioid prescription. In cases of complicated appendicitis, independent predictors of opioid prescription included older age (p=0.001), CT use without ultrasound (p<0.001) and shorter hospital stay (p<0.001). Discharge opioids were associated with increased odds of ED visits (aOR 1.28, 95% CI: 1.00-1.60), but not unplanned readmissions (aOR 1.13, CI 95%: 0.75-1.64).
Conclusion: Despite declining national rates, variation in opioid prescribing following appendectomy persists. Poor radiation stewardship and patient demographics appear to be associated with prescribing patterns. Efforts to optimize pain management and reduce unnecessary opioid exposure are warranted.
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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