Prevalence and Outcomes of Opioid Use Disorder in Pediatric Surgical Patients: A Retrospective Cohort Study.

BACKGROUND: Chronic opioid use among adolescents is a leading preventable public health problem in the United States. Consequently, a sizable proportion of surgical patients in this age group may have a comorbid opioid use disorder (OUD). No previously published study has examined the prevalence of OUD and its impact on postoperative morbidity or mortality in the adolescent surgical population. Our objective was to investigate the prevalence of comorbid OUD and its association with surgical outcomes in a US adolescent surgical population. We hypothesized that OUD among adolescent surgical patients is on an upward trajectory and that the presence of OUD is associated with higher risk of postoperative morbidity or mortality. METHODS: Using the pediatric health information system, we performed a 1:1 propensity score-matched, retrospective cohort study of adolescents (10-18 years of age) undergoing inpatient surgery between 2004 and 2019. The primary outcome was inpatient mortality. The secondary outcomes were surgical complications and postoperative infection. We also evaluated indicators of resource utilization, including mechanical ventilation, intensive care unit (ICU) admission, and postoperative length of stay (LOS). RESULTS: Of 589,098 adolescents, 563 (0.1%) were diagnosed with comorbid OUD (563 were matched on OUD). The prevalence of OUD in adolescents undergoing surgery increased from 0.4 per 1000 cases in 2004 to 1.6 per 1000 cases in 2019, representing an average annual percent change (AAPC) of 9.7% (95% confidence interval [CI], 5.7-13.9; P value < .001). The overall postoperative mortality rate was 0.50% (n = 2941). On univariable analysis, mortality rate was significantly higher in adolescents with comorbid OUD than those without comorbid OUD (3.37% vs 0.50%; P < .001). Among propensity-matched pairs, comorbid OUD diagnosis was associated with an estimated 57% relative increase in the risk of surgical complications (adjusted relative risk [aRR], 1.57; 95% CI, 1.24-2.00; P < .001). The relative risk of postoperative infection was 2-fold higher in adolescents with comorbid OUD than in those without OUD (aRR, 2.02; 95% CI, 1.62-2.51; P < .001). Adolescents with comorbid OUD had an increased risk of ICU admission, mechanical ventilation, and extended postoperative LOS. CONCLUSIONS: OUD is becoming increasingly prevalent in adolescents presenting for surgery. Comorbid OUD is an important determinant of surgical complications, postoperative infection, and resource utilization, underscoring the need to consider OUD as a critical, independent risk factor for postsurgical morbidity.

Economic Trends of Racial Disparities in Pediatric Postappendectomy Complications.

BACKGROUND: Despite unparalleled advances in perioperative medicine, surgical outcomes remain poor for racial minority patients relative to their white counterparts. Little is known about the excess costs to the health care system related to these disparities. METHODS: We performed a retrospective analysis of data from the Nationwide Inpatient Sample between 2001 and 2018. We included children younger than 18 years admitted with appendicitis who underwent an appendectomy during their hospital stay. We examined the inflation-adjusted hospital costs attributable to the racial disparities in surgical complications and perforation status, focusing on differences between non-Hispanic white patients and non-Hispanic Black patients. RESULTS: We included 100 639 children who underwent appendectomy, of whom 89.9% were non-Hispanic white and 10.1% were non-Hispanic Black. Irrespective of perforation status at presentation, surgical complications were consistently higher for Black compared with white children, with no evidence of narrowing of the racial disparity gap over time. Black children consistently incurred higher hospital costs (median difference: $629 [95% confidence interval: $500-$758; P < .01). The total inflation-adjusted hospital costs for Black children were $518 658 984, and $59 372 044 (11.41%) represented the excess because of the racial disparities in perforation rates. CONCLUSIONS: Although all patients had a progressive decline in post appendectomy complications, Black children consistently had higher rates of complications and perforation, imposing a significant economic burden. We provide an empirical economic argument for sustained efforts to reduce racial disparities in pediatric surgical outcomes, notwithstanding that eliminating these disparities is simply the right thing to do.