Abstract
PURPOSE: To evaluate the use of opioid analgesics for postoperative pain management in pediatric appendectomy patients in Japan, investigating individual and facility-related factors using hospital administrative data. METHODS: This study was a retrospective cohort study. Data was sourced from the Diagnosis Procedure Combination database. Inclusion criteria were: patients 2-18 years old; admitted and discharged between April 1st, 2018 and March 31, 2020; diagnosed with acute appendicitis; and who underwent appendectomy. The outcome was postoperative opioid use, calculated as the proportion of patients who used opioid from the day after surgery. RESULTS: There were 11,346 cases that were selected for the study. The overall proportion of patients who were administered postoperative opioids (POAP) was 9.47%. The POAP was similar across ages, sexes and types of surgery, but higher for patients with longer length of stay (LOS) and patients with abscess. The group that was administered opioids preoperatively had higher POAP. Inter-hospital variation was observed, as less than 40% of the hospitals were responsible for all patients who used postoperative opioids. Opioids were prescribed upon discharge to 0.01% patients. CONCLUSION: The POAP in pediatric appendectomy patients in Japan was lower than that observed in other countries, which might be attributed to legislation and opioid prescription culture. Hospital variation was observed, which might be related to the lack of guidelines and evidence-based recommendations, and to physician and hospital preferences. Future research is necessary for the development of guidelines that detail the appropriate use of opioids and avoid unnecessary exposure to pediatric patients.