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Wedoff M, Brinton DL, Maldonado L, Andrews AL, Simpson AN, Basco WT. Persistent Opioid Use Following Pediatric Nonfatal Firearm Injury. Acad Pediatr 2024; 24:783-790. [PMID: 38437979 DOI: 10.1016/j.acap.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Firearms are a major cause of pediatric injury. An analysis of opioid use following pediatric firearm injury has not previously been reported. Our objective was to determine the prevalence and factors associated with persistent opioid use among pediatric nonfatal firearm injury victims. METHODS We performed a retrospective cohort study using 2015-18 claims data from the Merative MarketScan Multi-State Medicaid and Commercial Databases, utilizing International Classification of Diseases, Tenth Revision codes for firearm injury and National Drug Codes for opioids. Dispensed opioid claims were used as a proxy for opioid use. Opioid exposure was defined both dichotomously and continuously (by the total number of opioid days prescribed) in the 30 days following discharge from firearm injury index encounter. Persistent opioid use was defined as ≥1 opioid claim(s) in the 90 to 270 days following index encounter. Multivariable logistic regression analysis was performed to determine whether covariates of interest were associated with greater odds of persistent opioid use. RESULTS Our cohort consisted of 2110 children who experienced nonfatal firearm injury (mean age 13.5, 80.9% male, 79.5% Medicaid) with 608 children (28.8%) exposed to opioids. Of patients exposed to opioids, 10.4% developed persistent opioid use. In adjusted analyses, each opioid day dispensed during the exposure period represented 5% greater odds of experiencing persistent opioid use. CONCLUSIONS Clinicians caring for children injured by firearms should be aware of the risk of developing persistent opioid use and balance that risk with the need to sufficiently control pain.
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Affiliation(s)
- Michael Wedoff
- Department of Pediatrics (M Wedoff and WT Basco), College of Medicine, Medical University of South Carolina, Charleston.
| | - Daniel L Brinton
- Department of Healthcare Leadership and Management (DL Brinton and L Maldonado), College of Health Professions, Medical University of South Carolina, Charleston.
| | - Lizmarie Maldonado
- Department of Healthcare Leadership and Management (DL Brinton and L Maldonado), College of Health Professions, Medical University of South Carolina, Charleston.
| | - Annie L Andrews
- Department of Pediatrics (A Andrews), The George Washington School of Medicine, DC.
| | - Annie N Simpson
- Real World Evidence (A Simpson), PrecisionHEOR, Boston, Mass.
| | - William T Basco
- Department of Pediatrics (M Wedoff and WT Basco), College of Medicine, Medical University of South Carolina, Charleston.
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Zhou Y, Huang J, Cao L, Gao Y, Li Y, Wang B, Pan B, Guo W, Cang J. Development of a nomogram for the early prediction of PACU VAS in patients undergoing laparoscopic radical resection of colorectal cancer with fentanyl. Heliyon 2023; 9:e18560. [PMID: 37554790 PMCID: PMC10404693 DOI: 10.1016/j.heliyon.2023.e18560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION To make early predictions of PACU VAS before surgery, we created a novel nomogram for the early prediction of PACU VAS in patients having laparoscopic radical excision of colorectal cancer with fentanyl. METHODS From July 2018 to December 2020, a total of 101 patients in Zhongshan Hospital Affiliated to Fudan University who underwent laparoscopic radical resection of colorectal cancer were enrolled in this study. For feature selection, a stepwise regression model was utilized. Multivariable logistic regression analysis was used to establish a prediction model. We incorporated age, gender, weight, height, fentanyl dosage during operation, operation time, and OPRM1 genotype, and this was presented with a nomogram. The nomogram's performance was evaluated in terms of discrimination and clinical utility. RESULTS The signature, which comprised of seven carefully chosen characteristics, was linked to the PACU VAS for the development dataset. Predictors contained in the individualized prediction nomogram included age, gender, weight, height, fentanyl dosage during operation, operation time, and OPRM1 genotype. With an area under the ROC curve of 0.877 (95% CI, 0.6874-1.0000), the model showed good discrimination. The nomogram still had good discrimination. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSIONS The nomogram presented in this study incorporates age, gender, weight, height, fentanyl dosage during operation, operation time, and OPRM1 genotype and can be conveniently used to facilitate the individualized prediction of PACU VAS in patients undergoing laparoscopic radical resection of colorectal cancer with fentanyl.
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Affiliation(s)
- Yan Zhou
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Jian Huang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Lei Cao
- Department of Pharmacy, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Yaoyi Gao
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Yihao Li
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Beili Wang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Baishen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Wei Guo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 111 Yi Xue Yuan Road, Shanghai, 200032, PR China
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Ruby JM, Illescas A, Zhong H, DelPizzo KR, Poeran J, Liu J, Cozowicz C, Memtsoudis SG. Pediatric anesthesia practices during the COVID‐19 pandemic: A retrospective cohort study. Health Sci Rep 2022; 6:e979. [PMCID: PMC9742494 DOI: 10.1002/hsr2.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
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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Affiliation(s)
- Jordan M. Ruby
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Alex Illescas
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA
| | - Kathryn R. DelPizzo
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jashvant Poeran
- Department of Population Health Science & Policy/Orthopedics, Icahn School of Medicine at Mount SinaiInstitute for Healthcare Delivery ScienceNew YorkNew YorkUSA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care MedicineParacelsus Medical UniversitySalzburgAustria
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA,Department of Health Policy and ResearchWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Wood MD, West NC, Sreepada R, Loftsgard KC, Petersen L, Robillard J, Page P, Ridgway R, Chadha NK, Portales-Casamar E, Görges M. Identifying risk factors, patient reported experience and outcome measures, and data capture tools for an individualized pain prediction tool in pediatrics: a focus group study (Preprint). JMIR Perioper Med 2022; 5:e42341. [DOI: 10.2196/42341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
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Kennedy H, Malik Z, Patel D. Persistent postoperative prescribing of opioids: a warning from the west? Comment on Br J Anaesth 2021; 126: 1192-9. Br J Anaesth 2021; 127:e202-e204. [PMID: 34561050 DOI: 10.1016/j.bja.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Helen Kennedy
- North West School of Anaesthesia, Health Education England North West, Manchester, UK.
| | - Zeeshan Malik
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - Davandra Patel
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
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