Background

The majority of opioid overdose admissions in pediatric patients are associated with prescription opioids. Post-operative prescriptions are an addressable source of opioids in the household. This study aims to assess for sustained reduction in opioid prescribing after implementation of provider-based education at nine centers.

Methods

Opioid prescribing information was collected for pediatric patients undergoing umbilical hernia repair at nine centers between December 2018 and January 2019, one year after the start of an education intervention. This was compared to prescribing patterns in the immediate pre- and post-intervention periods at each of the nine centers.

Results

In the current study period, 29/127 (22.8%) patients received opioid prescriptions (median 8 doses) following surgery. There were no medication refills, emergency department returns or readmissions related to the procedure. There was sustained reduction in opioid prescribing compared to pre-intervention (22.8% vs 75.8% of patients, p<0.001, Fig. (1). Five centers showed statistically significant improvement and the other four demonstrated decreased prescribing, though not statistically significant.

Conclusions

Our multicenter study demonstrates sustained reduction in opioid prescribing after pediatric umbilical hernia repair after a provider-based educational intervention. Similar low-fidelity provider education interventions may be beneficial to improve opioid stewardship for a wider variety of pediatric surgical procedures.

Levels of evidence

(treatment study)-level 3

中文翻译：

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提供者教育导致手术后儿科阿片类药物处方持续减少

背景

大多数儿科患者的阿片类药物过量入院与处方阿片类药物有关。术后处方是家庭中阿片类药物的可寻址来源。本研究旨在评估在九个中心实施基于提供者的教育后阿片类药物处方的持续减少。

方法

在教育干预开始一年后，于 2018 年 12 月至 2019 年 1 月期间，在九个中心为接受脐疝修复的儿科患者收集了阿片类药物处方信息。这与九个中心中每一个中心在干预前和干预后的即时处方模式进行了比较。

结果

在当前研究期间，29/127 (22.8%) 名患者在手术后接受了阿片类药物处方（中位数 8 剂）。没有与该程序相关的药物补充、急诊科返回或再入院。与干预前相比，阿片类药物处方持续减少（22.8% 对 75.8% 的患者，p <0.001，图（1）。五个中心显示出统计学上显着的改善，另外四个显示出处方减少，尽管没有统计学意义。

结论

我们的多中心研究表明，在基于提供者的教育干预后，儿科脐疝修复术后阿片类药物处方持续减少。类似的低保真提供者教育干预措施可能有助于改善对更广泛的儿科外科手术的阿片类药物管理。

证据级别

（治疗研究）- 3级