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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >SIGNIFICANT NATIONWIDE VARIATION EXISTS IN OPIOID PRESCRIPTION RATES AMONGST PEDIATRIC PATIENTS WITH ACL INJURIES: A RETROSPECTIVE COHORT STUDY
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SIGNIFICANT NATIONWIDE VARIATION EXISTS IN OPIOID PRESCRIPTION RATES AMONGST PEDIATRIC PATIENTS WITH ACL INJURIES: A RETROSPECTIVE COHORT STUDY

机译：患有ACL的小儿患者的阿片类药物处方率在全国范围内存在显着变化：一项回顾性队列研究

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Background: Prescription opioid rates have been found to vary on a county and state level. We aim to find if significant hospital-level and regional-level variation in opioid prescription rates exists in a pediatric orthopedic setting. Methods: We conducted a retrospective cohort study of children ages 10-18 who sustained an ACL injury between 2012-2016, from 39 hospitals throughout the United States, found through the Pediatric Health Information System. Patients were divided into four regions according to the regional census of hospital admission, and demographics were recorded. Primary outcomes were hospital-level variation in opioid prescription rates using a mixed effects linear regression model to compare mean differences in average opioid prescription rate. Results: 11,452 pediatric patients were analyzed for regional-level variation in opioid prescription rates. Of those patients 7,879 were analyzed for hospital-level variation in opioid prescription rates based on if the hospital of incidence had a sample size of at least 250 patients over the five-year span (16 of the 43 hospitals fit this criteria). The most common demographics were patients ages 16-18 (n=5,613; 49.01%), white (n=6,588; 57.53%), and male (n=5,905; 51.56%). The 11,452 patients were divided into four regions: (1) Northeast (n=2,409; 21.04%), (2) Midwest (n=2,499; 21.82%), (3) South (n=3,869; 33.78%), and (4) West (n=2,675; 23.36%). After adjustment, significant variation in opioid prescription rates was found to exist at both a hospital-level using a random intercept and random slope model (-2LL=17882.381, p&.05) and at a regional-level by comparing mean differences in average opioid prescription rate (p&.05). Conclusions: Significant variation of opioid prescription rates exists at both a hospital-level and a regional-level over the last five years in a pediatric orthopedic setting. The findings of this study build off previous findings from the Centers for Disease Control, which found significant variation existed in opioid prescription rates on a state-wide level. Given the recent guidelines proposed by the CDC to control and limit prescription opioids (as of March 2016), future studies finding the impact of the guidelines on variation of prescription rates in a pediatric orthopedic setting could be beneficial. Table 1:. Mean Difference in Opioid Prescription Rate (Regional Comparison by Year) Region 1 Region 2 2012 2013 2014 2015 2016 Midwest Northeast 0.608* 0.738* 0.829* 0.512* 0.634* Midwest South -0.109 -0.165* 0.020 -0.153* -0.014 Midwest West 0.113 0.133 0.417* 0.247* 0.335* Northeast South -0.717* -0.904* -0.809* -0.665* -0.648* Northeast West -0.495* -0.606* -0.411* -0.266* -0.299* South West 0.223* 0.298* 0.397* 0.400* 0.350* *p&.05 Table 1: A comparison of mean differences in opioid prescription rates. Table 1 compares the mean differences between opioid prescription rates for five years, on a regional level. An asterisk (*) indicates that at p&.05, the opioid prescription rate varied significantly for the regions compared within that year. A negative value indicates that region 1 prescribed fewer opioids than region 2. A positive value indicates that region 2 prescribed more opioids than region 1. Figure 1:. Total opioid variation across years describing regional variation
机译：背景：发现阿片类药物处方率在县和州范围内有所不同。我们的目标是发现在儿科骨科医院中阿片类药物处方率的医院水平和区域水平是否存在显着差异。方法：我们通过儿童健康信息系统对全美39家医院的2012年至2016年间ACL损伤的10-18岁儿童进行了回顾性队列研究。根据入院地区人口普查将患者分为四个区域，并记录人口统计数据。主要结果是使用混合效应线性回归模型比较平均阿片类药物处方率的平均差异后，医院水平的阿片类药物处方率变化。结果：分析了11,452名儿科患者的阿片类药物处方率区域差异。在这些患者中，对7879名患者的阿片类药物处方率变化进行了分析，基于发生率的医院在过去5年中是否有至少250名患者（43家医院中的16家符合这一标准）。最常见的人口统计资料是16-18岁的患者（n = 5,613; 49.01％），白人（n = 6,588; 57.53％）和男性（n = 5,905; 51.56％）。 11,452例患者分为四个区域：（1）东北（n = 2,409; 21.04％），（2）中西部（n = 2,499; 21.82％），（3）南部（n = 3,869; 33.78％），以及（ 4）西（n = 2,675; 23.36％）。调整后，发现在医院一级使用随机截距和随机斜率模型（-2LL = 17882.381，p <.05）的阿片类药物处方率存在显着差异，而在区域一级通过比较平均值的平均差异发现阿片类药物处方率存在显着差异阿片类药物处方率（p ＜.05）。结论：过去五年来，在小儿骨科医院中，阿片类药物处方率在医院级和地区级均存在显着差异。这项研究的结果是根据疾病控制中心以前的发现得出的，该发现发现在全州范围内，阿片类药物处方率存在显着差异。考虑到CDC提出的控制和限制处方阿片类药物的最新指南（截至2016年3月），未来的研究发现该指南对儿科骨科患者处方率变化的影响可能是有益的。表格1：。阿片类药物处方率平均差异（按地区分区域比较）1地区2 2012 2013 2014 2015 2016中西部东北地区0.608 * 0.738 * 0.829 * 0.512 * 0.634 *中西部南部-0.109 -0.165 * 0.020 -0.153 * -0.014中西部西部0.113 0.133 0.417 * 0.247 * 0.335 *东北南部-0.717 * -0.904 * -0.809 * -0.665 * -0.648 *东北西部-0.495 * -0.606 * -0.411 * -0.266 * -0.299 *西南0.223 * 0.298 * 0.397 * 0.400 * 0.350 ** p ＜.05表1：阿片类药物处方率平均差异的比较。表1比较了区域一级五年内阿片类药物处方率之间的平均差异。星号（*）表示当年p <.05时，该地区的阿片类药物处方率有显着变化。负值表示区域1规定的阿片类药物比区域2少。正值表示区域2规定的阿片类药物比区域1多。图1 ：。多年来阿片类药物的总变化描述了区域变化

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