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PLoS One. 2018 Feb 8;13(2):e0192529. doi: 10.1371/journal.pone.0192529. eCollection 2018.

Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia.

Getz KD1,2, Miller TP1, Seif AE1,3, Li Y1,4, Huang YV2, Fisher BT2,3,4,5, Aplenc R1,2,3,4.

Author information

1
Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
2
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
3
Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America.
4
Center for Clinical Epidemiology and Biostatistics, Unive of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America.
5
Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.

Abstract

PURPOSE:

A cohort of pediatric patients with AML treated at hospitals contributing to the Pediatric Health Information System was used to evaluate differences in opioid utilization by sex, age, race, and insurance.

METHODS:

Billing data were used to compute the prevalence of opioid exposure and to quantify rates of utilization among those exposed to opioids as days of use per 1000 inpatient days. Multivariable regressions were used to compare opioid prevalence, and rates of utilization among those exposed.

RESULTS:

On average across courses, 95.2% of patients were exposed to analgesics, 84.7% were exposed to non-opioid analgesics and 77.7% were exposed to opioids. The proportion of opioid-exposed patients increased with age, but did not differ by gender, race, or insurance status. Analyses limited to patients exposed to opioids revealed modest differences in days of opioid use among female patients (adjusted rate ratio (aRR) = 1.19, 95% CI: 1.11, 1.28), patients <1 year (aRR = 1.37, 95% CI: 1.21, 1.55) or ≥10 years of age (aRR = 1.63, 95% CI: 1.46, 1.82), whereas Asian patients received fewer days of opioids compared with white patients (aRR = 0.76, 95% CI: 0.61, 0.95). There was moderate hospital-level variability in both the prevalence of opioid utilization overall and preference for specific opioid medications. There was greater inconsistency in practice concerning choices for supplemental and alternative opioids than in first-line opioid utilization.

CONCLUSION:

Additional work is needed to discern whether observed differences in opioid utilization by age and race reflect a difference in treatment or a difference in the experience of pain. Future studies should also explore the factors which guide decisions on opioid selections in an attempt to explain the variability across institutions.

PMID:
29420604
PMCID:
PMC5805309
DOI:
10.1371/journal.pone.0192529
[Indexed for MEDLINE]
Free PMC Article

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