Persistent opioid use after surgical treatment of paediatric fracture

Zhong, Haoyan; Ladenhauf, Hannah N.; Wilson, Laird; Liu, Jiabin; DelPizzo, Kathryn; Poeran, Jashvant; Memtsoudis, Stavros G.

doi:10.1016/j.bja.2020.12.044

Cited by 8 publications

(6 citation statements)

References 30 publications

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“…A large number of pediatric orthopaedic patients receive opioid prescriptions for analgesia. 6,8,13,14,15,16 Several studies have investigated prescription volume by procedure type (Table 1), and while the data is still limited, the current results show little correlation between fracture type, sex, and opioid doses.…”

Section: Variation In Prescription Volumecontrasting

confidence: 54%

“…5 However, in a large study of a nationally representative claims database, 21.5% of pediatric patients undergoing surgical fracture treatment filled one or more opioid prescriptions. 6 Since fractures are one of the most common injuries in children and adolescents 7 and fracture surgery is becoming increasingly common, more research is needed to determine trends of pediatric opioid prescriptions as well as the trend specifically in orthopaedic patients.…”

Section: Pediatric Opioid Usementioning

confidence: 99%

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Variation in Prescribing Patterns and Use of Opioids in Pediatric Orthopaedic Surgery Patients

Procaccini

Cruz

2021

Journal of the Pediatric Orthopaedic Society of North America

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Pediatric patients receiving opioid prescriptions after orthopaedic surgery are an at-risk population amidst the ongoing opioid epidemic in the United States. While there is significant literature about opioid prescribing patterns and consumption among the adult population, there is limited data in the pediatric population. As a result of this limited knowledge, there remains substantial variation in practice patterns surrounding opioid use. This review evaluates the current literature regarding variation in opioid prescribing patterns in pediatric orthopaedic surgery patients with the aim of increasing awareness of risks and potential interventions.

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Section: Variation In Prescription Volumecontrasting

confidence: 54%

Section: Pediatric Opioid Usementioning

confidence: 99%

Variation in Prescribing Patterns and Use of Opioids in Pediatric Orthopaedic Surgery Patients

Procaccini

Cruz

2021

Journal of the Pediatric Orthopaedic Society of North America

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“…Studies have demonstrated that pediatric patients frequently develop PPSP, which may include patterns of persistent opioid use following surgery [ 1 , 4 , 33 , 34 ]. A wide range of risk factors have been identified, including some that may be amenable to preoperative [ 4 , 35 - 39 ] or perioperative [ 33 ] mitigation; these are broadly in line with the findings of this study and include pre-existing chronic pain and presurgical pain intensity, pain coping, child anxiety, preoperative opioid/substance use, depression, and poor sleep quality.…”

Section: Discussionmentioning

confidence: 99%

Identifying Risk Factors, Patient-Reported Experience and Outcome Measures, and Data Capture Tools for an Individualized Pain Prediction Tool in Pediatrics: Focus Group Study

Wood,

West,

Sreepada

et al. 2022

JMIR Perioper Med

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Background The perioperative period is a data-rich environment with potential for innovation through digital health tools and predictive analytics to optimize patients’ health with targeted prehabilitation. Although some risk factors for postoperative pain following pediatric surgery are already known, the systematic use of preoperative information to guide personalized interventions is not yet widespread in clinical practice. Objective Our long-term goal is to reduce the incidence of persistent postsurgical pain (PPSP) and long-term opioid use in children by developing personalized pain risk prediction models that can guide clinicians and families to identify targeted prehabilitation strategies. To develop such a system, our first objective was to identify risk factors, outcomes, and relevant experience measures, as well as data collection tools, for a future data collection and risk modeling study. Methods This study used a patient-oriented research methodology, leveraging parental/caregiver and clinician expertise. We conducted virtual focus groups with participants recruited at a tertiary pediatric hospital; each session lasted approximately 1 hour and was composed of clinicians or family members (people with lived surgical experience and parents of children who had recently undergone a procedure requiring general anesthesia) or both. Data were analyzed thematically to identify potential risk factors for pain, as well as relevant patient-reported experience and outcome measures (PREMs and PROMs, respectively) that can be used to evaluate the progress of postoperative recovery at home. This guidance was combined with a targeted literature review to select tools to collect risk factor and outcome information for implementation in a future study. Results In total, 22 participants (n=12, 55%, clinicians and n=10, 45%, family members) attended 10 focus group sessions; participants included 12 (55%) of 22 persons identifying as female, and 12 (55%) were under 50 years of age. Thematic analysis identified 5 key domains: (1) demographic risk factors, including both child and family characteristics; (2) psychosocial risk factors, including anxiety, depression, and medical phobias; (3) clinical risk factors, including length of hospital stay, procedure type, medications, and pre-existing conditions; (4) PREMs, including patient and family satisfaction with care; and (5) PROMs, including nausea and vomiting, functional recovery, and return to normal activities of daily living. Participants further suggested desirable functional requirements, including use of standardized and validated tools, and longitudinal data collection, as well as delivery modes, including electronic, parent proxy, and self-reporting, that can be used to capture these metrics, both in the hospital and following discharge. Established PREM/PROM questionnaires, pain-catastrophizing scales (PCSs), and substance use questionnaires for adolescents were subsequently selected for our proposed data collection platform. Conclusions This study established 5 key data domains for identifying pain risk factors and evaluating postoperative recovery at home, as well as the functional requirements and delivery modes of selected tools with which to capture these metrics both in the hospital and after discharge. These tools have been implemented to generate data for the development of personalized pain risk prediction models.

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“…Procedures included surgical intervention for fractures separated by the location of the fracture (shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankle, and foot and toe) and surgical intervention for ACL/UCL repair. 10 , 11 Using billing data, we identified the anesthesia type for each patient. Those without billing information for anesthesia type were excluded from the analysis ( n = 3128).…”

Section: Methodsmentioning

confidence: 99%

“…Patient records with an International Classification of Diseases, 10th Revision, Clinical Modification (ICD‐10‐CM) procedure code or Current Procedural Terminology (CPT) code for surgical intervention of a fracture or ACL/UCL repair were included in this cohort (Appendix: Table A1). Procedures included surgical intervention for fractures separated by the location of the fracture (shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankle, and foot and toe) and surgical intervention for ACL/UCL repair 10,11 . Using billing data, we identified the anesthesia type for each patient.…”

Section: Methodsmentioning

confidence: 99%

Pediatric anesthesia practices during the COVID‐19 pandemic: A retrospective cohort study

Ruby

Illescas

Zhong

et al. 2022

Health Science Reports

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Background and Aims The onset of the coronavirus 2019 (COVID‐19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use. Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. Methods Using the Premier Health Database, we retrospectively analyzed pediatric patients undergoing a surgical intervention for fractures or ligament repair before and during COVID‐19. We sought to determine if there were differences in anesthesia use among this cohort during the two time periods. Fracture groups included shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankles, and foot and toes. Ligament procedures included surgical intervention for the anterior cruciate ligament and ulnar collateral ligament repair. Results We identified a total of 5935 patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. After exclusion for unknown anesthesia use, 2,807 patients were included in our cohort with 81.5% ( n = 2288) of patients undergoing a procedure under general anesthesia, 6.4% ( n = 181) under regional anesthesia, and 12.0% ( n = 338) under combined general‐regional anesthesia. There did not appear to be a significant difference in the type of anesthesia used before and during COVID‐19 ( p = 0.052). Conclusions Our study did not identify a difference in anesthesia use before and during COVID‐19 among pediatric patients undergoing a surgical procedure. Further studies should estimate the change in anesthesia used during the time period when elective procedures were resumed.

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Persistent opioid use after surgical treatment of paediatric fracture

Cited by 8 publications

References 30 publications

Variation in Prescribing Patterns and Use of Opioids in Pediatric Orthopaedic Surgery Patients

Variation in Prescribing Patterns and Use of Opioids in Pediatric Orthopaedic Surgery Patients

Identifying Risk Factors, Patient-Reported Experience and Outcome Measures, and Data Capture Tools for an Individualized Pain Prediction Tool in Pediatrics: Focus Group Study

Pediatric anesthesia practices during the COVID‐19 pandemic: A retrospective cohort study

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