Fewer postoperative opioids are associated with decreased duration of stay for children with perforated appendicitis
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Feb 2021 · 1 min read
In brief
In brief
This large retrospective study of nearly 48,000 pediatric patients found that opioid use on postoperative day 1 after appendectomy for perforated appendicitis was associated with 0.75-day longer hospital stays, with continued opioid use extending stays by nearly 2 days. The findings suggest minimizing opioid analgesia may reduce length of stay without affecting readmission rates.
Written by the GCMD Library team from the article.
Background: The impact of postoperative opioid use on outcomes for children with perforated appendicitis is unknown.
Methods: A retrospective cohort study was performed using the Pediatric Health Information System database from 2005 to 2015. Children 2 to 18 years with perforated appendicitis who underwent an appendectomy were identified. Postoperative day analgesic use was categorized as nonopioid analgesia alone, opioids (with or without nonopioid analgesia), or no analgesics. The impact of postoperative opioid use on postoperative duration of stay and 30-day readmission was evaluated using multivariable mixed-effects regression analysis.
Results: Overall, 47,726 children with perforated appendicitis were identified. On postoperative day 1, 17.7% received nonopioid analgesia alone, 77.6% received opioids, and 4.7% received no analgesics. On adjusted analysis, postoperative day 1 opioid use was associated with a 0.75-day (95% confidence interval: 0.54-0.96) increased postoperative duration of stay. Starting opioids after postoperative day 1 was associated with 2.21 days (95% confidence interval: 1.90-2.51) longer postoperative duration of stay. Among children who received opioids on postoperative day 1, continued use of opioids after postoperative day 1 was associated with a 1.88 day (95% confidence interval: 1.77-1.98) longer postoperative duration of stay. Postoperative day 1 opioid use did not significantly affect 30-day readmission.
Conclusion: Early and continued postoperative opioid use is associated with prolonged postoperative duration of stay in children undergoing appendectomy for perforated appendicitis. Minimizing opioid use, even on postoperative day 2, may result in a decreased postoperative duration of stay.
DOI: 10.1016/j.surg.2020.04.060