Opioid Prescribing and Use After Pediatric Umbilical Hernia Repair

2020 ◽  
Vol 86 (5) ◽  
pp. 437-440
Author(s):  
Matthew L. Lee ◽  
Lauren B. Camp ◽  
Mehul V. Raval ◽  
Eunice Y. Huang
Keyword(s):  
Adverse Events ◽  
Hernia Repair ◽  
Pain Control ◽  
Umbilical Hernia ◽  
Parent Report ◽  
Physician Education ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Umbilical Hernia Repair ◽  
Before And After

Background Opioid overuse is a concern in adult and pediatric populations. Physician education may improve appropriate opioid prescribing and patient instruction for use. Prescribing and use of opioid for pain control after pediatric umbilical hernia repair (UH) before and after surgeon education was evaluated. This is a substudy of a multi-institutional study assessing prescribing practice before and after surgeon education. This study further assessed patient prescription filling pattern and parent report of pain control. Methods A retrospective study was performed evaluating children who underwent UH 6 months before and after an educational presentation on opioid use. Prescriptions, prescription fills, patient medication use, and pain control effectiveness were assessed. Adverse events were collected. Results There were 78 subjects in the pre- and 99 in the posteducation group. Opioid prescribed changed from 98.7% to 61.6% ( P < .0001), and nonopioid prescriptions increased following education ( P = .0063). The number of opioid prescriptions filled decreased ( P = .0296). There were limited data on opioid doses used and quality of pain control, but the posteducation group showed good pain control. There was no difference in adverse events. Discussion Surgeon education on current opioid epidemic and strategies for opioid stewardship improves opioid prescribing and use without adversely impacting pain control or clinical outcome.

Opioid Prescribing and Use After Pediatric Umbilical Hernia Repair

2020 ◽  
pp. 000313482094738
Author(s):  
Matthew L. Lee ◽  
Lauren B. Camp ◽  
Mehul V. Raval ◽  
Eunice Y. Huang
Keyword(s):  
Adverse Events ◽  
Pain Control ◽  
Umbilical Hernia ◽  
Parent Report ◽  
Physician Education ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Education Group ◽  
Umbilical Hernia Repair ◽  
Before And After

Background Opioid overuse is a concern in adult and pediatric populations. Physician education may improve appropriate opioid prescribing and patient instruction for use. Prescribing and use of opioids for pain control after pediatric umbilical hernia (UH) repair before and after surgeon education was evaluated. This is a substudy of a multi-institutional study assessing prescribing practice before and after surgeon education. This study further assessed patient prescription filling patterns and parent report of pain control. Methods A retrospective study was performed evaluating children who underwent UH 6 months before and after an educational presentation on opioid use. Prescriptions, prescription fills, patient medication use, and pain control effectiveness were assessed. Adverse events were collected. Results There were 78 subjects in the pre-education and 99 in the post-education group. Opioid prescribed changed from 98.7% to 61.6% ( P < .0001), and nonopioid prescriptions increased following education ( P = .0063). The number of opioid prescriptions filled decreased ( P = .0296). There were limited data on opioid doses used and quality of pain control, but the post-education group showed good pain control. There was no difference in adverse events. Discussion Surgeon education on the current opioid epidemic and strategies for opioid stewardship improves opioid prescribing and use without adversely impacting pain control or clinical outcome.

A pilot study of the rectus sheath block for pain control after umbilical hernia repair

2006 ◽  
Vol 16 (4) ◽  
pp. 406-409 ◽  
Author(s):  
LISA A. ISAAC ◽  
JUDITH McEWEN ◽  
JASON A. HAYES ◽  
MARK W. CRAWFORD
Keyword(s):  
Pilot Study ◽  
Hernia Repair ◽  
Pain Control ◽  
Umbilical Hernia ◽  
Rectus Sheath ◽  
Umbilical Hernia Repair ◽  
Rectus Sheath Block

Provider education decreases opioid prescribing after pediatric umbilical hernia repair

2020 ◽  
Vol 55 (7) ◽  
pp. 1319-1323 ◽  
Author(s):  
Kaitlin N. Piper ◽  
Katherine J. Baxter ◽  
Martha Wetzel ◽  
Courtney McCracken ◽  
Curtis Travers ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Provider Education ◽  
Opioid Prescribing ◽  
Umbilical Hernia Repair

Effect of a Standardized Electronic Medical Record Order Set on Opioid Prescribing after Tonsillectomy

2020 ◽  
Vol 163 (2) ◽  
pp. 216-220 ◽  
Author(s):  
Joshua D. Horton ◽  
Corinne Corrigan ◽  
Terral Patel ◽  
Caroline Schaffer ◽  
Robert A. Cina ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Pain Control ◽  
Retrospective Chart Review ◽  
Postoperative Hemorrhage ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Before And After ◽  
Order Set

Objective Approximately 5% of children develop new persistent opioid use after tonsillectomy. Critical review of our prescribing practices revealed inconsistent and excessive opioid prescribing after this procedure in children. We sought to improve our practice by using a standardized electronic medical record (EMR)–based order set. Methods Retrospective chart review of outpatient tonsillectomy performed before and after institution of an EMR intervention with comparison of opioid and nonopioid analgesic (NOA) prescription characteristics as well as outcomes including hemorrhage and readmission. Results Analysis of 276 preorder set and 128 post–order set tonsillectomies revealed a significant increase in NOA utilization following initiation of the order set and a significant reduction in doses of opioid prescribed. Due to a change to a stronger opioid in the order set, morphine dose equivalents (MDEs) prescribed were not decreased in the post–order set cohort. Variability between prescriptions and providers was significantly decreased in the post–order set group in terms of doses and MDEs, and dangerously high outlier prescriptions were eliminated. No differences in pain control, postoperative hemorrhage, presentation to the emergency department, or readmission were identified. Discussion An EMR-based intervention improved the quality and safety of posttonsillectomy opioid prescribing at our institution. Moving forward, this order set provides a platform with which to titrate opioid prescriptions and NOA to optimal pain control and safety levels. Implications for Practice A standardized EMR-based order set can improve the quality of opioid prescribing after tonsillectomy.

scholarly journals Effect of Laparoscopic Total Extraperitoneal Umbilical Hernia Repair on Incision Infection, Complication Rate, and Recurrence Rate in Patients with Umbilical Hernia

2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Zhao Zhang ◽  
Li Li ◽  
Bo Liu ◽  
Fengen Wang ◽  
Wenli Wang ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hernia Repair ◽  
Recurrence Rate ◽  
Umbilical Hernia ◽  
Operation Time ◽  
Intraoperative Blood Loss ◽  
Umbilical Hernia Repair ◽  
Total Extraperitoneal ◽  
Before And After ◽  
Infection Complication

The aim of this study is to clarify the influence of laparoscopic total extraperitoneal umbilical hernia repair on incision infection, complication rate, and recurrence rate in patients with an umbilical hernia (UH). Sixty-seven UH patients referred to our hospital from June 2017 to June 2019 were selected as the research participants. Thirty-six patients in the research group (RG) were treated with laparoscopic total extraperitoneal umbilical hernia repair, and the other 31 cases in the control group (CG) were treated with traditional umbilical hernia repair. The two cohorts of patients were compared with respect to the curative effect after treatment; intraoperative blood loss, operation time, postoperative pain time, ambulation time, and hospital stay; incidence of complications; pain severity (VAS) before and after operation; sleep quality (PSQI) before and after operation; patient satisfaction after treatment; and recurrence half a year after discharge. The RG presented a higher effective treatment rate ( P  < 0.05), less intraoperative blood loss, operation time, postoperative pain time, ambulation time, and hospital stay, as well as lower incidence of complications than the CG ( P  < 0.05). VAS and PSQI scores differed insignificantly between the two cohorts of patients before treatment ( P  > 0.05) but reduced after treatment, with lower VAS and PSQI scores in the RG than in the CG ( P  < 0.05). The number of people who were highly satisfied, as investigated by the satisfaction survey, was higher in the RG than in the CG, while the recurrence rate of prognosis was lower than that in the CG ( P  < 0.05). Laparoscopic total extraperitoneal umbilical hernia repair is effective for UH patients and can validly reduce the incidence of complications and recurrence rate, which has huge clinical application value.

National variation in opioid prescribing after pediatric umbilical hernia repair

Surgery ◽  
2019 ◽  
Vol 165 (4) ◽  
pp. 838-842 ◽  
Author(s):  
Randi S. Cartmill ◽  
Dou-Yan Yang ◽  
Sara Fernandes-Taylor ◽  
Jonathan Emerson Kohler
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Opioid Prescribing ◽  
Umbilical Hernia Repair

Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

2021 ◽  
pp. 1-9
Author(s):  
Aakriti R. Carrubba ◽  
Amy E. Glasgow ◽  
Elizabeth B. Habermann ◽  
Amanda P. Stanton ◽  
Megan N. Wasson ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Cohort Analysis ◽  
Oral Morphine ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Before And After ◽  
Legislative Changes

<b><i>Objectives:</i></b> This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. <b><i>Design:</i></b> This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. <b><i>Methods:</i></b> Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum <i>t</i> tests for OMEs and χ<sup>2</sup> <i>t</i> tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). <b><i>Results:</i></b> In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate remained unchanged at 7.4% (<i>p</i> = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; <i>p</i> = 0.739). <b><i>Limitations:</i></b> Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. <b><i>Conclusions:</i></b> Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

Umbilical Hernia Repair

2019 ◽  
pp. 279-281
Author(s):  
Katherine Culbreath ◽  
Daniel Rhee
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Umbilical Hernia Repair
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