The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy

McLaughlin, Cory; Squillaro, Anthony I.; Ourshaliman, Shadassa; Song, Ashley; Lakshmanan, Ashwini; Cucchiaro, Giovanni; Hall, Matthew; Burke, Rita V.; Kelley-Quon, Lorraine I.

doi:10.1016/j.clinthera.2019.07.002

Cited by 10 publications

(5 citation statements)

References 33 publications

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“…This prior study suggests that avoidance of opioids in the postoperative period after pyloromyotomy may help limit complications. 4 Our current study aligns with our previous results, as infants that received opioid analgesics at any time other than the DOS alone had higher room and board costs. On bivariate analysis, opioids given on the DOS alone were associated with lower overall resource utilization, but after controlling for patient factors we found this association to be no longer significant.…”

Section: Discussionsupporting

confidence: 91%

“…2,3 Our group has previously found an association between postoperative opioid use and prolonged inpatient length of stay in infants undergoing pyloromyotomy for HPS. 4 However, the impact of opioid use on healthcare resource utilization and costs associated with infants undergoing pyloromyotomy is not known. Using a large, nationally representative hospital administrative claims dataset, we hypothesized that opioid analgesia use after pyloromyotomy is associated with increased resource utilization and costs.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Opioid Analgesia Impacts Resource Utilization in Infants Undergoing Pyloromyotomy

Squillaro

Ourshalimian

McLaughlin

et al. 2020

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Postoperative Opioid Analgesia Impacts Resource Utilization in Infants Undergoing Pyloromyotomy

Squillaro

Ourshalimian

McLaughlin

et al. 2020

Journal of Surgical Research

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“… 1 , 2 , 3 , 9 In addition to potentially worse clinical outcomes, high-risk infants in centers that more commonly prescribe opioids likely have increased short-term costs and increased long-term health care use. 21 , 22 , 23 , 24 , 25 , 26 Understanding regional and institutional variation can inform best-practice initiatives and encourage practitioners to carefully consider when opioids are the appropriate medications for the patient.…”

Section: Introductionmentioning

confidence: 99%

Institutional and Regional Variation in Opioid Prescribing for Hospitalized Infants in the US

Keane,

Ourshalimian,

Lakshmanan

et al. 2024

JAMA Netw Open

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ImportanceHigh-risk infants, defined as newborns with substantial neonatal-perinatal morbidities, often undergo multiple procedures and require prolonged intubation, resulting in extended opioid exposure that is associated with poor outcomes. Understanding variation in opioid prescribing can inform quality improvement and best-practice initiatives.ObjectiveTo examine regional and institutional variation in opioid prescribing, including short- and long-acting agents, in high-risk hospitalized infants.Design, Setting, and ParticipantsThis retrospective cohort study assessed high-risk infants younger than 1 year from January 1, 2016, to December 31, 2022, at 47 children’s hospitals participating in the Pediatric Health Information System (PHIS). The cohort was stratified by US Census region (Northeast, South, Midwest, and West). Variation in cumulative days of opioid exposure and methadone treatment was examined among institutions using a hierarchical generalized linear model. High-risk infants were identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for congenital heart disease surgery, medical and surgical necrotizing enterocolitis, extremely low birth weight, very low birth weight, hypoxemic ischemic encephalopathy, extracorporeal membrane oxygenation, and other abdominal surgery. Infants with neonatal opioid withdrawal syndrome, in utero substance exposure, or malignant tumors were excluded.ExposureAny opioid exposure and methadone treatment.Main Outcomes and MeasuresRegional and institutional variations in opioid exposure.ResultsOverall, 132 658 high-risk infants were identified (median [IQR] gestational age, 34 [28-38] weeks; 54.5% male). Prematurity occurred in 30.3%, and 55.3% underwent surgery. During hospitalization, 76.5% of high-risk infants were exposed to opioids and 7.9% received methadone. Median (IQR) length of any opioid exposure was 5 (2-12) cumulative days, and median (IQR) length of methadone treatment was 19 (7-46) cumulative days. There was significant hospital-level variation in opioid and methadone exposure and cumulative days of exposure within each US region. The computed intraclass correlation coefficient estimated that 16% of the variability in overall opioid prescribing and 20% of the variability in methadone treatment was attributed to the individual hospital.Conclusions and RelevanceIn this retrospective cohort study of high-risk hospitalized infants, institution-level variation in overall opioid exposure and methadone treatment persisted across the US. These findings highlight the need for standardization of opioid prescribing in this vulnerable population.

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“…Exploring data from >25,000 infants who underwent pyloromyotomy, the investigators report that receiving opioids on the day of surgery resulted in decreased odds of prolonged hospital stay, whereas receiving opioids on both the day of surgery and postoperatively increased the odds of a prolonged hospitalization. 11 This report highlights the need to consider standardization of opioid pain therapy in infants and young children and to optimize the timing of drug delivery.…”

mentioning

confidence: 99%

“…10 These clinical care approaches are vital to improving the health outcomes of newborns undergoing surgical and/or painful procedures. As McLaughlin et al 11 report in one of the largest analyses to date that explored perioperative opioid use for infants undergoing pyloromyotomy, there is huge site-to-site variation in opioid pain management. Exploring data from >25,000 infants who underwent pyloromyotomy, the investigators report that receiving opioids on the day of surgery resulted in decreased odds of prolonged hospital stay, whereas receiving opioids on both the day of surgery and postoperatively increased the odds of a prolonged hospitalization.…”

mentioning

confidence: 99%

Finding Hope: Clinical Strategies to Combat the Devastating Impact of the Opioid Epidemic on our Youth

Maron

2019

Clinical Therapeutics

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Addiction to opioids has become a global public health threat that does not discriminate based on sex, socioeconomic status, race, ethnicity, or age. In recent years, there has been an exponential increase in opioid overdoses and drug-related deaths. According to the National Institute on Drug Abuse, in 2017 > 70,200 Americans died of drug overdoses, including >17,000 deaths that involved prescription drugs. 1 These sobering statistics equate to a 2-fold increase in drug-related deaths in the United States in the past decade alone. 1 Tragically, children have not been spared from this epidemic. Gaither et al 2 recently reported that between 1999 and 2016 the pediatric mortality rate from prescription and illicit opioid poisonings increased by 268.2%. These deaths were not limited to the adolescent population, but rather spanned the pediatric age spectrum from 0 to 18 years. 2 Effects of opioids on the health of our children may start as early as in utero and continue through adolescence with devastating and often unmitigated effects of addiction. Compounding these effects are the multigenerational and transgenerational consequences of drug exposure. Parental drug exposure produces behavioral, biochemical, and neuroanatomic changes in future generations through a combination of genetic, epigenetic, and environmental influences that results in a vicious cycle of chronic drug abuse. 3 In this Specialty Update, we consider the impact of opioids throughout the pediatric age spectrumdfrom fetuses to teenagersdand present new therapeutic and treatment strategies aimed at reducing the burden of drug addiction and improving the health outcomes of our youth. In 2016, 1 in 5 women of reproductive age filled at least 1 prescription for an opioid, and an estimated 15.3% of women reported the misuse of prescription drugs or illicit drug use. 4 As a result, an estimated 32,000 babies are born in the United States each year with neonatal abstinence syndrome (NAS), now commonly referred to as neonatal opioid withdrawal syndrome. These numbers equate to an infant being born every 15 min in the United States addicted to opioids, a greater than 5-fold increase since 2004, and result in medical costs of US$563 million per year. 4 The long-term effects of these narcotics on the developing fetal brain remain largely unknown. 5 Most adults exposed to illicit drugs in utero may be physically healthy, but data suggest that vulnerability to health and neurocognitive issues are pervasive and long lasting. 6 Perhaps the optimal strategy to reduce drug exposure in infants is to limit drug use in pregnant women. It is well known that abrupt cessation of narcotics during pregnancy poses significant health threats for both mother and fetus. 7 Thus, strategies to engage mothers in treatment programs during pregnancy, along with the development of new treatment agents, are a priority. The pure opioid antagonist, naltrexone, is currently used by 11% of young adults with opioid use disorders. 8 To date, the safety profile and efficacy of this drug i...

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The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy

Cited by 10 publications

References 33 publications

Postoperative Opioid Analgesia Impacts Resource Utilization in Infants Undergoing Pyloromyotomy

Postoperative Opioid Analgesia Impacts Resource Utilization in Infants Undergoing Pyloromyotomy

Institutional and Regional Variation in Opioid Prescribing for Hospitalized Infants in the US

Finding Hope: Clinical Strategies to Combat the Devastating Impact of the Opioid Epidemic on our Youth

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