In summary, the data is consistent with a racial disparity specifically highlighted in black children in our pre-intervention cohort, which was eliminated following our intervention.
David Grabski, MD - Best of the Best in Pediatric Surgery 2024
▶Ep 4 · 0:17
quoteWe implemented a multimodal intervention to reduce postoperative opiate use in children at our institution based on IV Tylenol, directed post-operative pain education seminars for related faculty and staff, and standardized post-surgical sign out.↗
▶Ep 4 · 0:17
clinicalThe intervention was based on IV Tylenol, directed post-operative pain education seminars for related faculty and staff, and standardized post-surgical sign out.↗
▶Ep 4 · 1:00
clinicalThe study included 250 children under 1 year old who underwent non-emergent abdominal surgery in either the NICU or the acute care floor.↗
▶Ep 4 · 2:00
clinicalThe intervention reduced post-operative opiate use by 98% in the study population.↗
▶Ep 4 · 2:30
epidemiologicalIn the pre-intervention cohort, the median postoperative morphine equivalence for Black children was 13 mg per kilogram, while for White children it was 2 mg per kilogram, and for Hispanic children it was 3.5 mg per kilogram.↗
▶Ep 4 · 3:00
quoteThis represents a sixfold increase in post-operative opiate use in black children compared to their white peers.↗
▶Ep 4 · 3:00
epidemiologicalBlack children received a sixfold increase in post-operative opiate use compared to their White peers in the pre-intervention cohort.↗
▶Ep 4 · 3:20
clinicalIn the post-intervention cohort, the median postoperative morphine equivalence in Black children reduced to just above 0 mg per kilogram, while for White children it was 0.05 mg per kilogram, and for Hispanic children it was 0.1 mg per kilogram, with these findings being statistically equivalent.↗
▶Ep 4 · 4:00
epidemiologicalThere was no statistical difference in demographic or clinical variables in the pre-intervention or post-intervention cohort when analyzed by race.↗
▶Ep 4 · 4:00
quoteIn summary, the data is consistent with a racial disparity specifically highlighted in black children in our pre-intervention cohort, which was eliminated following our intervention.↗
▶Ep 4 · 4:20
epidemiologicalThe type of surgery performed in each cohort was proportionally equivalent by race.↗
▶Ep 4 · 4:30
clinicalThere was no difference in postoperative pain scores in any racial group.↗
▶Ep 4 · 4:40
epidemiologicalThe median total length of stay for Black children in the pre-intervention cohort was 45 days, while for White children it was 16 days.↗
▶Ep 4 · 5:00
clinicalFollowing the intervention, the total length of stay for Black children was 8 days, which was identical to White children.↗
▶Ep 4 · 5:15
clinicalA racial disparity was found in the pre-intervention cohort in length of post-operative intubation and TPN usage, both of which were eliminated following the clinical protocol.↗
▶Ep 4 · 5:42
opinionPreliminary data suggests there might be a disparity in regional anesthesia use.↗
▶Ep 4 · 6:00
opinionStandardization at all levels (pre-surgery, surgery, post-surgery, and throughout the NICU phase) was critical to the work.↗
▶Ep 4 · 7:12
opinionSocioeconomic status associated with race was likely significant in the disparity.↗
▶Ep 4 · 7:40
opinionParents at bedside help with consoling and driving care, and that level of presence in the NICU was probably important.↗
▶Ep 4 · 7:40
quoteParents at bedside help. It, it helps with consoling, it helps driving care. I think that there was a um That That that level of presence in the NICU was probably important.↗
▶Ep 4 · 8:00
clinicalAt UVA during the study and at Lurie Children's currently, PRNs are often delivered by bedside nurses.↗
▶Ep 4 · 8:20
clinicalAt UVA, the NAS pain score was used and if it reached a threshold, a PRN (usually fentanyl) was delivered.↗
