Postoperative Opioid Analgesia Impacts Resource Utilization in Infants Undergoing Pyloromyotomy.
Analgesics, Opioid
/ economics
Cost-Benefit Analysis
Drug Costs
/ statistics & numerical data
Female
Health Resources
/ economics
Hospital Costs
/ statistics & numerical data
Humans
Infant
Length of Stay
/ economics
Male
Models, Economic
Pain Management
/ economics
Pain, Postoperative
/ drug therapy
Pyloric Stenosis, Hypertrophic
/ economics
Pyloromyotomy
/ adverse effects
Retrospective Studies
United States
Opioid
Pyloric stenosis
Pyloromyotomy
Resource utilization
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
28
02
2020
revised:
14
05
2020
accepted:
24
05
2020
pubmed:
12
7
2020
medline:
15
12
2020
entrez:
12
7
2020
Statut:
ppublish
Résumé
Opioid analgesia is often avoided in infants undergoing pyloromyotomy. Previous studies highlight an association between opioid use and prolonged hospitalization after pyloromyotomy. However, the impact of opioid use on healthcare resource utilization and cost is unknown. We hypothesized that use of opioids after pyloromyotomy is associated with increased resource utilization and costs. A retrospective cohort study was conducted identifying healthy infants aged <6 mo with a diagnosis of pyloric stenosis who underwent pyloromyotomy from 2005 to 2015 among 47 children's hospitals using the Pediatric Health Information System database. Time of opioid exposure was categorized as day of surgery (DOS) alone, postoperative use alone, or combined DOS and postoperative use. Primary outcomes were the standardized unit cost, a proxy for resource utilization, billed charges to the patient/insurer, and hospital costs. A multivariable log-linear mixed-effects model was used to adjust for patient and hospital level factors. Overall, 11,008 infants underwent pyloromyotomy with 2842 (26%) receiving perioperative opioids. Most opioid use was confined to the DOS alone (n = 2,158, 19.6%). Infants who received opioids on DOS and postoperatively exhibited 13% (95% confidence interval [CI]: 7%-20%, P-value <0.001) higher total resource utilization compared with infants who did not receive any opioids. Billed charges were 3% higher (95% CI: 0%-5%, P-value = 0.034) for infants receiving opioids isolated to the postoperative period alone and 6% higher (95% CI: 2%-11%, P-value = 0.004) for infants receiving opioids on the DOS and postoperatively. Postoperative opioid use among infants who underwent pyloromyotomy was associated with increased resource utilization and costs.
Sections du résumé
BACKGROUND
Opioid analgesia is often avoided in infants undergoing pyloromyotomy. Previous studies highlight an association between opioid use and prolonged hospitalization after pyloromyotomy. However, the impact of opioid use on healthcare resource utilization and cost is unknown. We hypothesized that use of opioids after pyloromyotomy is associated with increased resource utilization and costs.
METHODS
A retrospective cohort study was conducted identifying healthy infants aged <6 mo with a diagnosis of pyloric stenosis who underwent pyloromyotomy from 2005 to 2015 among 47 children's hospitals using the Pediatric Health Information System database. Time of opioid exposure was categorized as day of surgery (DOS) alone, postoperative use alone, or combined DOS and postoperative use. Primary outcomes were the standardized unit cost, a proxy for resource utilization, billed charges to the patient/insurer, and hospital costs. A multivariable log-linear mixed-effects model was used to adjust for patient and hospital level factors.
RESULTS
Overall, 11,008 infants underwent pyloromyotomy with 2842 (26%) receiving perioperative opioids. Most opioid use was confined to the DOS alone (n = 2,158, 19.6%). Infants who received opioids on DOS and postoperatively exhibited 13% (95% confidence interval [CI]: 7%-20%, P-value <0.001) higher total resource utilization compared with infants who did not receive any opioids. Billed charges were 3% higher (95% CI: 0%-5%, P-value = 0.034) for infants receiving opioids isolated to the postoperative period alone and 6% higher (95% CI: 2%-11%, P-value = 0.004) for infants receiving opioids on the DOS and postoperatively.
CONCLUSIONS
Postoperative opioid use among infants who underwent pyloromyotomy was associated with increased resource utilization and costs.
Identifiants
pubmed: 32652313
pii: S0022-4804(20)30352-8
doi: 10.1016/j.jss.2020.05.077
pmc: PMC7541571
mid: NIHMS1610116
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
594-601Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001854
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
Int Anesthesiol Clin. 2019 Fall;57(4):15-24
pubmed: 31503092
Pediatrics. 2001 Jun;107(6):E99
pubmed: 11389297
Lancet. 2009 Jan 31;373(9661):390-8
pubmed: 19155060
Spine (Phila Pa 1976). 2014 Sep 15;39(20):1676-82
pubmed: 24983937
Arch Dis Child. 1979 Nov;54(11):886-9
pubmed: 526031
Surgery. 2011 Jun;149(6):830-40
pubmed: 21236454
Laryngoscope. 2000 Nov;110(11):1824-7
pubmed: 11081593
Jt Comm J Qual Patient Saf. 2008 Nov;34(11):627-8
pubmed: 19025082
J Pediatr Surg. 2007 Apr;42(4):692-8
pubmed: 17448768
Paediatr Anaesth. 2015 Dec;25(12):1193-206
pubmed: 26490352
Eur J Pediatr Surg. 2011 Mar;21(2):77-81
pubmed: 20957601
J Cardiovasc Electrophysiol. 2013 Feb;24(2):162-9
pubmed: 23066833
BMC Pediatr. 2014 Aug 08;14:199
pubmed: 25102958
J Pediatr Surg. 2014 Jul;49(7):1083-6
pubmed: 24952793
Int J Pediatr Otorhinolaryngol. 2019 Aug;123:175-180
pubmed: 31125911
Surgery. 2019 Aug;166(2):172-176
pubmed: 31126588
Pediatrics. 2000 Jul;106(1 Pt 2):205-9
pubmed: 10888693
J Pediatr Surg. 2002 Jul;37(7):1068-71; discussion 1068-71
pubmed: 12077773
Eur J Cardiothorac Surg. 2011 Sep;40(3):610-3
pubmed: 21342774
J Pediatr Surg. 2018 Apr;53(4):688-692
pubmed: 28545764
J Pediatr Surg. 2018 Aug;53(8):1472-1477
pubmed: 29241960
Paediatr Perinat Epidemiol. 1997 Oct;11(4):407-27
pubmed: 9373863
Clin Ther. 2019 Sep;41(9):1690-1700
pubmed: 31409555
Curr Opin Pediatr. 2018 Jun;30(3):399-404
pubmed: 29629980
J Pain Res. 2010 Jul 15;3:105-23
pubmed: 21197314
J Pediatr Surg. 2006 Oct;41(10):1676-8
pubmed: 17011267
World J Urol. 2010 Apr;28(2):215-9
pubmed: 19565247
J Surg Res. 2012 Nov;178(1):315-20
pubmed: 22480835
Ann Surg. 2006 Sep;244(3):363-70
pubmed: 16926562
Pediatr Surg Int. 2017 Jan;33(1):43-51
pubmed: 27679510
JAMA. 1999 Feb 17;281(7):644-9
pubmed: 10029127
Eur J Pediatr Surg. 2001 Feb;11(1):12-4
pubmed: 11370975
J Pain Symptom Manage. 2014 Nov;48(5):903-14
pubmed: 24703942