Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study
Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements. To test the primary hypothesis tha...
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| Veröffentlicht in: | Journal of clinical anesthesia 2020-06, Vol.62, p.109729-109729, Article 109729 |
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| creator | Cohen, Barak Tanios, Marianne A. Koyuncu, Onur Yilmaz, Huseyin Oguz Raza, Syed Mukhdomi, Junaid Artis, Amanda S. Seif, John Chhabada, Surendrasingh Turan, Alparslan |
| description | Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements.
To test the primary hypothesis that increased BMI in pediatric patients is associated with increased pain during the initial 48 postoperative hours. Secondarily, we tested whether BMI is associated with increased opioid consumption during the same period.
Retrospective single-center cohort study.
Pediatric surgical wards in a tertiary medical center.
A total of 808 opioid naïve patients aged 8 to 18 years having elective non-cardiac surgery with hospital stay of at least 48 h in the Cleveland Clinic between 2010 and 2015.
None.
Using U.S. Centers for Disease Control definitions for childhood weight classifications, we retrospectively evaluated the association between body mass index (BMI) percentile and time-weighted average pain scores and opioid consumption. We used multivariable linear regression to test for an association with postoperative pain scores, and multivariable gamma regression to test for an association with postoperative opioid consumption (in mg morphine equivalents Kg−1).
BMI was not associated with postoperative pain after general, orthopedic, or neuro-spinal surgeries. Pain increased by 0.07 [98.75% CI: (0.01, 0.13), Padj |
| doi_str_mv | 10.1016/j.jclinane.2020.109729 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2350087859</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0952818019311262</els_id><sourcerecordid>2425682732</sourcerecordid><originalsourceid>FETCH-LOGICAL-c396t-4dbdeb1370947efa6022080839cac27d09e5afac8767f415739c4ec8afc0358f3</originalsourceid><addsrcrecordid>eNqFkU1uFDEQhS0EIkPgCpElNmx6qHb_2N4xRPxESsQmWVseu5pxa6ZtbHei7NhwAm7ISfDMJCyyYWW56qtX9nuEnNWwrKHu34_L0WzdpCdcMmD7ouRMPiOLWvCmajsmn5MFyI5VohZwQl6lNAJAadQvyUnDAHoBsCC_Vil543R2fqJrzHeIE9247xuM9OPVBdWTpcGn7APGAt0iDdpNh7IPzjtLjZ_SvAsHgdIJaItadKZcQpnAKSf65-dvuqIRc_QpoDnoGL_xMdOUZ3v_mrwY9Dbhm4fzlNx8_nR9_rW6_Pbl4nx1WZlG9rlq7drium44yJbjoHtgDASIRhptGLcgsdODNoL3fGjrjpdGi0bowUDTiaE5Je-OuiH6HzOmrHYuGdxui49-Too1HYDgopMFffsEHf0cp_I6xVrW9YLxhhWqP1Km_CxFHFSIbqfjvapB7YNSo3oMSu2DUsegyuDZg_y83qH9N_aYTAE-HAEsftw6jCqZYqYp9sbioLLe_W_HX4abqng</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2425682732</pqid></control><display><type>article</type><title>Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study</title><source>Elsevier ScienceDirect Journals</source><creator>Cohen, Barak ; Tanios, Marianne A. ; Koyuncu, Onur ; Yilmaz, Huseyin Oguz ; Raza, Syed ; Mukhdomi, Junaid ; Artis, Amanda S. ; Seif, John ; Chhabada, Surendrasingh ; Turan, Alparslan</creator><creatorcontrib>Cohen, Barak ; Tanios, Marianne A. ; Koyuncu, Onur ; Yilmaz, Huseyin Oguz ; Raza, Syed ; Mukhdomi, Junaid ; Artis, Amanda S. ; Seif, John ; Chhabada, Surendrasingh ; Turan, Alparslan</creatorcontrib><description>Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements.
To test the primary hypothesis that increased BMI in pediatric patients is associated with increased pain during the initial 48 postoperative hours. Secondarily, we tested whether BMI is associated with increased opioid consumption during the same period.
Retrospective single-center cohort study.
Pediatric surgical wards in a tertiary medical center.
A total of 808 opioid naïve patients aged 8 to 18 years having elective non-cardiac surgery with hospital stay of at least 48 h in the Cleveland Clinic between 2010 and 2015.
None.
Using U.S. Centers for Disease Control definitions for childhood weight classifications, we retrospectively evaluated the association between body mass index (BMI) percentile and time-weighted average pain scores and opioid consumption. We used multivariable linear regression to test for an association with postoperative pain scores, and multivariable gamma regression to test for an association with postoperative opioid consumption (in mg morphine equivalents Kg−1).
BMI was not associated with postoperative pain after general, orthopedic, or neuro-spinal surgeries. Pain increased by 0.07 [98.75% CI: (0.01, 0.13), Padj < 0.05] points per 5 percentile increase in BMI after neuro-cranial surgery. Higher BMI was associated with a decrease in postoperative opioid consumption (mean change [95% CI] −2.12% [−3.12%, −1.10%] in morphine equivalents Kg−1 per 5 percentile increase in BMI, P < 0.001).
We found no clinically important increase in pain scores or opioid consumption in association with higher BMI in patients 8 to 18 years of age recovering from elective non-cardiac surgery.
•Anesthesiologists face an increasing number of obese pediatric surgical patients.•Some data suggest that obese patients have increased pain and analgesic requirements.•We report an analysis of pediatric patients recovering from non-cardiac surgery.•Increased BMI was not associated with significantly increased postoperative pain.•Postoperative opioid consumption was also not increased in patients with increased BMI.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2020.109729</identifier><identifier>PMID: 32006800</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Analgesics ; Body mass index ; Cohort analysis ; Confidence intervals ; Disease control ; Electronic health records ; Hemoglobin ; Hospitalization ; Hypotheses ; Medical personnel ; Medical records ; Morphine ; Narcotics ; Obesity ; Overweight ; Pain ; Pediatrics ; Postoperative period ; Regression analysis ; Surgical outcomes</subject><ispartof>Journal of clinical anesthesia, 2020-06, Vol.62, p.109729-109729, Article 109729</ispartof><rights>2020</rights><rights>Copyright © 2020. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Jun 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-4dbdeb1370947efa6022080839cac27d09e5afac8767f415739c4ec8afc0358f3</citedby><cites>FETCH-LOGICAL-c396t-4dbdeb1370947efa6022080839cac27d09e5afac8767f415739c4ec8afc0358f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0952818019311262$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32006800$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cohen, Barak</creatorcontrib><creatorcontrib>Tanios, Marianne A.</creatorcontrib><creatorcontrib>Koyuncu, Onur</creatorcontrib><creatorcontrib>Yilmaz, Huseyin Oguz</creatorcontrib><creatorcontrib>Raza, Syed</creatorcontrib><creatorcontrib>Mukhdomi, Junaid</creatorcontrib><creatorcontrib>Artis, Amanda S.</creatorcontrib><creatorcontrib>Seif, John</creatorcontrib><creatorcontrib>Chhabada, Surendrasingh</creatorcontrib><creatorcontrib>Turan, Alparslan</creatorcontrib><title>Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements.
To test the primary hypothesis that increased BMI in pediatric patients is associated with increased pain during the initial 48 postoperative hours. Secondarily, we tested whether BMI is associated with increased opioid consumption during the same period.
Retrospective single-center cohort study.
Pediatric surgical wards in a tertiary medical center.
A total of 808 opioid naïve patients aged 8 to 18 years having elective non-cardiac surgery with hospital stay of at least 48 h in the Cleveland Clinic between 2010 and 2015.
None.
Using U.S. Centers for Disease Control definitions for childhood weight classifications, we retrospectively evaluated the association between body mass index (BMI) percentile and time-weighted average pain scores and opioid consumption. We used multivariable linear regression to test for an association with postoperative pain scores, and multivariable gamma regression to test for an association with postoperative opioid consumption (in mg morphine equivalents Kg−1).
BMI was not associated with postoperative pain after general, orthopedic, or neuro-spinal surgeries. Pain increased by 0.07 [98.75% CI: (0.01, 0.13), Padj < 0.05] points per 5 percentile increase in BMI after neuro-cranial surgery. Higher BMI was associated with a decrease in postoperative opioid consumption (mean change [95% CI] −2.12% [−3.12%, −1.10%] in morphine equivalents Kg−1 per 5 percentile increase in BMI, P < 0.001).
We found no clinically important increase in pain scores or opioid consumption in association with higher BMI in patients 8 to 18 years of age recovering from elective non-cardiac surgery.
•Anesthesiologists face an increasing number of obese pediatric surgical patients.•Some data suggest that obese patients have increased pain and analgesic requirements.•We report an analysis of pediatric patients recovering from non-cardiac surgery.•Increased BMI was not associated with significantly increased postoperative pain.•Postoperative opioid consumption was also not increased in patients with increased BMI.</description><subject>Analgesics</subject><subject>Body mass index</subject><subject>Cohort analysis</subject><subject>Confidence intervals</subject><subject>Disease control</subject><subject>Electronic health records</subject><subject>Hemoglobin</subject><subject>Hospitalization</subject><subject>Hypotheses</subject><subject>Medical personnel</subject><subject>Medical records</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Obesity</subject><subject>Overweight</subject><subject>Pain</subject><subject>Pediatrics</subject><subject>Postoperative period</subject><subject>Regression analysis</subject><subject>Surgical outcomes</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1uFDEQhS0EIkPgCpElNmx6qHb_2N4xRPxESsQmWVseu5pxa6ZtbHei7NhwAm7ISfDMJCyyYWW56qtX9nuEnNWwrKHu34_L0WzdpCdcMmD7ouRMPiOLWvCmajsmn5MFyI5VohZwQl6lNAJAadQvyUnDAHoBsCC_Vil543R2fqJrzHeIE9247xuM9OPVBdWTpcGn7APGAt0iDdpNh7IPzjtLjZ_SvAsHgdIJaItadKZcQpnAKSf65-dvuqIRc_QpoDnoGL_xMdOUZ3v_mrwY9Dbhm4fzlNx8_nR9_rW6_Pbl4nx1WZlG9rlq7drium44yJbjoHtgDASIRhptGLcgsdODNoL3fGjrjpdGi0bowUDTiaE5Je-OuiH6HzOmrHYuGdxui49-Too1HYDgopMFffsEHf0cp_I6xVrW9YLxhhWqP1Km_CxFHFSIbqfjvapB7YNSo3oMSu2DUsegyuDZg_y83qH9N_aYTAE-HAEsftw6jCqZYqYp9sbioLLe_W_HX4abqng</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Cohen, Barak</creator><creator>Tanios, Marianne A.</creator><creator>Koyuncu, Onur</creator><creator>Yilmaz, Huseyin Oguz</creator><creator>Raza, Syed</creator><creator>Mukhdomi, Junaid</creator><creator>Artis, Amanda S.</creator><creator>Seif, John</creator><creator>Chhabada, Surendrasingh</creator><creator>Turan, Alparslan</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202006</creationdate><title>Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study</title><author>Cohen, Barak ; Tanios, Marianne A. ; Koyuncu, Onur ; Yilmaz, Huseyin Oguz ; Raza, Syed ; Mukhdomi, Junaid ; Artis, Amanda S. ; Seif, John ; Chhabada, Surendrasingh ; Turan, Alparslan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-4dbdeb1370947efa6022080839cac27d09e5afac8767f415739c4ec8afc0358f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Analgesics</topic><topic>Body mass index</topic><topic>Cohort analysis</topic><topic>Confidence intervals</topic><topic>Disease control</topic><topic>Electronic health records</topic><topic>Hemoglobin</topic><topic>Hospitalization</topic><topic>Hypotheses</topic><topic>Medical personnel</topic><topic>Medical records</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Obesity</topic><topic>Overweight</topic><topic>Pain</topic><topic>Pediatrics</topic><topic>Postoperative period</topic><topic>Regression analysis</topic><topic>Surgical outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cohen, Barak</creatorcontrib><creatorcontrib>Tanios, Marianne A.</creatorcontrib><creatorcontrib>Koyuncu, Onur</creatorcontrib><creatorcontrib>Yilmaz, Huseyin Oguz</creatorcontrib><creatorcontrib>Raza, Syed</creatorcontrib><creatorcontrib>Mukhdomi, Junaid</creatorcontrib><creatorcontrib>Artis, Amanda S.</creatorcontrib><creatorcontrib>Seif, John</creatorcontrib><creatorcontrib>Chhabada, Surendrasingh</creatorcontrib><creatorcontrib>Turan, Alparslan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cohen, Barak</au><au>Tanios, Marianne A.</au><au>Koyuncu, Onur</au><au>Yilmaz, Huseyin Oguz</au><au>Raza, Syed</au><au>Mukhdomi, Junaid</au><au>Artis, Amanda S.</au><au>Seif, John</au><au>Chhabada, Surendrasingh</au><au>Turan, Alparslan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2020-06</date><risdate>2020</risdate><volume>62</volume><spage>109729</spage><epage>109729</epage><pages>109729-109729</pages><artnum>109729</artnum><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract>Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements.
To test the primary hypothesis that increased BMI in pediatric patients is associated with increased pain during the initial 48 postoperative hours. Secondarily, we tested whether BMI is associated with increased opioid consumption during the same period.
Retrospective single-center cohort study.
Pediatric surgical wards in a tertiary medical center.
A total of 808 opioid naïve patients aged 8 to 18 years having elective non-cardiac surgery with hospital stay of at least 48 h in the Cleveland Clinic between 2010 and 2015.
None.
Using U.S. Centers for Disease Control definitions for childhood weight classifications, we retrospectively evaluated the association between body mass index (BMI) percentile and time-weighted average pain scores and opioid consumption. We used multivariable linear regression to test for an association with postoperative pain scores, and multivariable gamma regression to test for an association with postoperative opioid consumption (in mg morphine equivalents Kg−1).
BMI was not associated with postoperative pain after general, orthopedic, or neuro-spinal surgeries. Pain increased by 0.07 [98.75% CI: (0.01, 0.13), Padj < 0.05] points per 5 percentile increase in BMI after neuro-cranial surgery. Higher BMI was associated with a decrease in postoperative opioid consumption (mean change [95% CI] −2.12% [−3.12%, −1.10%] in morphine equivalents Kg−1 per 5 percentile increase in BMI, P < 0.001).
We found no clinically important increase in pain scores or opioid consumption in association with higher BMI in patients 8 to 18 years of age recovering from elective non-cardiac surgery.
•Anesthesiologists face an increasing number of obese pediatric surgical patients.•Some data suggest that obese patients have increased pain and analgesic requirements.•We report an analysis of pediatric patients recovering from non-cardiac surgery.•Increased BMI was not associated with significantly increased postoperative pain.•Postoperative opioid consumption was also not increased in patients with increased BMI.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32006800</pmid><doi>10.1016/j.jclinane.2020.109729</doi><tpages>1</tpages></addata></record> |
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| ispartof | Journal of clinical anesthesia, 2020-06, Vol.62, p.109729-109729, Article 109729 |
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| source | Elsevier ScienceDirect Journals |
| subjects | Analgesics Body mass index Cohort analysis Confidence intervals Disease control Electronic health records Hemoglobin Hospitalization Hypotheses Medical personnel Medical records Morphine Narcotics Obesity Overweight Pain Pediatrics Postoperative period Regression analysis Surgical outcomes |
| title | Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study |
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