Abstract:
Importance:Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. Objective:To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery. Evidence Review:Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique. Findings:Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery. Conclusions and Relevance:These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.
journal_name
JAMA Surgjournal_title
JAMA surgeryauthors
Kelley-Quon LI,Kirkpatrick MG,Ricca RL,Baird R,Harbaugh CM,Brady A,Garrett P,Wills H,Argo J,Diefenbach KA,Henry MCW,Sola JE,Mahdi EM,Goldin AB,St Peter SD,Downard CD,Azarow KS,Shields T,Kim Edoi
10.1001/jamasurg.2020.5045subject
Has Abstractpub_date
2021-01-01 00:00:00pages
76-90issue
1eissn
2168-6254issn
2168-6262pii
2772855journal_volume
156pub_type
杂志文章相关文献
JAMA Surgery文献大全abstract:Importance:Both military and civilian clinical practice guidelines include early plasma transfusion to achieve a plasma to red cell ratio approaching 1:1 to 1:2. However, it was not known how early plasma should be given for optimal benefit. Two recent randomized clinical trials were published, with apparently contradi...
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2019.5085
更新日期:2020-02-01 00:00:00
abstract:IMPORTANCE:In recent years, the CD40/CD40L system has been implicated in the pathophysiology of severe chronic inflammatory diseases. Recently, obesity has been described as a low chronic inflammatory disease, so this system could also be involved in the inflammatory process. OBJECTIVE:To study soluble CD40 ligand (sC...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurgery.2013.419
更新日期:2013-02-01 00:00:00
abstract:IMPORTANCE:Thoracic endovascular aortic repair (TEVAR) is used in the treatment of type B aortic dissections. Information related to aortic morphologic findings and the condition of the abdominal aorta after TEVAR is limited. OBJECTIVE:To analyze aortic morphologic findings after TEVAR for type B aortic dissections. ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1327
更新日期:2014-09-01 00:00:00
abstract:IMPORTANCE:To reduce the amount of skin surface bacteria for patients undergoing elective surgery, selective health care facilities have instituted a preadmission antiseptic skin cleansing protocol using chlorhexidine gluconate. A Cochrane Collaborative review suggests that existing data do not justify preoperative ski...
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2015.2210
更新日期:2015-11-01 00:00:00
abstract:Importance:To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer. Objectiv...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2017.0461
更新日期:2017-08-01 00:00:00
abstract:IMPORTANCE:Postoperative pulmonary complications can be a devastating consequence of surgery. Validated strategies to reduce these adverse outcomes are needed. OBJECTIVES:To design, implement, and determine the efficacy of a suite of interventions for reducing postoperative pulmonary complications. DESIGN:A before-af...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.358
更新日期:2013-08-01 00:00:00
abstract::Fibroepithelial lesions (FELs) are a common histologic finding on core needle biopsy (CNB) of the breast. Fibroepithelial lesions include fibroadenoma and phyllodes tumor, which can be difficult to distinguish with an initial CNB. An institutional experience was reviewed from February 12, 2001, to January 4, 2007, to ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.73
更新日期:2014-10-01 00:00:00
abstract:Importance:Surgical options for weight loss vary considerably in risks and benefits, but the relative importance of procedure-associated characteristics in patient decision making is largely unknown. Objective:To identify patient preferences for risks, benefits, and other attributes of treatment options available to i...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.4375
更新日期:2019-01-01 00:00:00
abstract:IMPORTANCE:Hemorrhage is the leading cause of death in military trauma and second leading cause of death in civilian trauma. Although many well-established animal models of hemorrhage exist in the trauma and anticoagulant literature, few focus on directly quantitating blood loss. OBJECTIVE:To establish and validate a ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1685
更新日期:2015-04-01 00:00:00
abstract:IMPORTANCE:Nonsteroidal anti-inflammatory drugs (NSAIDs) have many physiologic effects and are being used more commonly to treat postoperative pain, but recent small studies have suggested that NSAIDs may impair anastomotic healing in the gastrointestinal tract. OBJECTIVE:To evaluate the relationship between postopera...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.2239
更新日期:2015-03-01 00:00:00
abstract:Importance:Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted car...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.5674
更新日期:2017-06-01 00:00:00
abstract:Importance:Older adults are disproportionately affected by trauma and accounted for 47% of trauma fatalities in 2016. In many populations and disease processes, described risk factors for poor clinical outcomes include sarcopenia and brain atrophy, but these remain to be fully characterized in older trauma patients. Sa...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.0988
更新日期:2019-08-01 00:00:00
abstract:IMPORTANCE:To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. OBJECTIVE:To assess the effect of different types of bariatric surgery in patients with T2DM on diabetes remis...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.2398
更新日期:2015-12-01 00:00:00
abstract:Importance:Medically treated symptomatic severe aortic stenosis has poor outcomes, and in the past 6 decades, it has successfully been treated with surgical aortic valve replacement (SAVR). However, one-third of patients with indications for SAVR are not offered surgery because of the high risk of complications. Transc...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.4449
更新日期:2019-11-27 00:00:00
abstract:IMPORTANCE:Trauma is known to be one of the strongest risk factors for pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin therapy for prevention of PE, but trauma places some patients at risk of excess bleeding. Experts are divided on the role of prophylactic inferior vena cava (IVC) fil...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2013.3970
更新日期:2014-02-01 00:00:00
abstract:IMPORTANCE:The appropriately coached implementation of surgical safety checklists (SSCs) reduces the incidence of perioperative complications and 30-day mortality of patients undergoing surgery. The association of the introduction of SSCs with 90-day mortality remains unclear. OBJECTIVE:To assess the association betwe...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.5490
更新日期:2016-07-01 00:00:00
abstract:Importance:Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives:To evaluate if abstinence from smoking on the day of surgery is associated with a decreased frequency ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.5704
更新日期:2017-05-01 00:00:00
abstract:IMPORTANCE:Surgical site infection remains a major challenge in surgery. Delayed primary closure of dirty wounds is widely practiced in war surgery; we present a meta-analysis of evidence to help guide application of the technique in wider context. OBJECTIVE:To determine using meta-analysis whether delayed primary ski...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2013.2336
更新日期:2013-08-01 00:00:00
abstract:Importance:Incisional hernia is a frequent complication after open abdominal surgery. Prophylactic mesh implantation in the onlay or sublay position requires dissection of the abdominal wall, potentially leading to wound-associated complications. Objective:To compare the incidence of incisional hernia among patients a...
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2018.4221
更新日期:2019-02-01 00:00:00
abstract:IMPORTANCE:Patient- and hospital-level factors affecting outcomes after open and endovascular abdominal aortic aneurysm (AAA) repair are each well described separately, but not together. OBJECTIVE:To describe the association of patient- and hospital-level factors with in-hospital mortality after elective AAA repair. ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.0782
更新日期:2016-09-01 00:00:00
abstract:Importance:Growing consensus suggests that frailty-associated risks should inform shared surgical decision making. However, it is not clear how best to screen for frailty in preoperative surgical populations. Objective:To develop and validate the Risk Analysis Index (RAI), a 14-item instrument used to measure surgical...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4202
更新日期:2017-02-01 00:00:00
abstract:Importance:There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. Objective:To identify factors driving end-of-life decisions in vascular surgery patients. Design, Setting, and Participants:In this cohort study, medical records were reviewed for all vascular sur...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.3970
更新日期:2017-02-01 00:00:00
abstract:IMPORTANCE:Minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring remains the standard approach to the majority of patients with primary hyperparathyroidism. This study demonstrates that individual patient characteristics do not affect existing criteria for intraoperative parathyroid h...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.104
更新日期:2013-07-01 00:00:00
abstract:IMPORTANCE:Morphometric assessment has emerged as a strong predictor of postoperative morbidity and mortality. However, a gap exists in translating this knowledge to bedside decision making. We introduced a novel measure of patient-centered surgical risk assessment: morphometric age. OBJECTIVE:To investigate the relat...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.4823
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:To describe the current state of the science for operating room (OR) briefings and debriefings, including an overview of key definitions, a review of the evidence of effectiveness, and a summary of our experiences as part of a comprehensive unit-based safety program. OVERVIEW:Use of preoperative briefings h...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.172
更新日期:2014-08-01 00:00:00
abstract:Importance:Autologous fat transfer (AFT or fat grafting) has become an invaluable tool for the correction of disfiguring deformities after breast cancer surgery. However, clinical and animal studies have shown conflicting results regarding its oncologic safety. Objective:To determine whether exposure to AFT vs convent...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.3744
更新日期:2019-01-01 00:00:00
abstract:IMPORTANCE:The field of transplantation has made tremendous progress since the first successful kidney transplant in 1954. OBJECTIVE:To determine the survival benefit of solid-organ transplant as recorded during a 25-year study period in the United Network for Organ Sharing (UNOS) database and the Social Security Admi...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.2038
更新日期:2015-03-01 00:00:00
abstract:IMPORTANCE:Research has been limited on the incidence, mechanisms, etiology, and treatment of symptoms that require palliation in patients with terminal cancer. Bowel obstruction (BO) is a common complication of advanced abdominal cancer, including colon cancer, for which small, single-institution studies have suggeste...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.1
更新日期:2013-08-01 00:00:00
abstract:Importance:Investigating outcomes after marginal allograft transplant is essential in determining appropriate and more aggressive use of these allografts. Objective:To determine the time trends in the outcomes of marginal liver allografts as defined by 6 different sets of criteria. Design, Setting, and Participants:I...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.2484
更新日期:2020-08-05 00:00:00
abstract:IMPORTANCE:Maintaining perioperative normothermia has been shown to decrease the rate of surgical site infection (SSI) after segmental colectomy and is part of the World Health Organization's Guidelines for Safe Surgery. However, strong evidence supporting this association is lacking, and an exact definition of normoth...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.77
更新日期:2015-06-01 00:00:00