title: The Association Between Adjuvant Pain Medication Use and Outcomes Following Pediatric Spinal Fusion.
abstract: METHODS
  A comparative effectiveness database study.
  
  
  OBJECTIVE
  The aim of this study was to describe variation in use of adjuvant therapies for managing postoperative pain in in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and determine association between use of these therapies and patient outcomes.
  
  
  BACKGROUND
  Variation in postoperative pain management for children undergoing PSF for AIS likely impacts outcomes. Minimal evidence exists to support strategies that most effectively minimize prolonged intravenous (IV) opioids and hospitalizations.
  
  
  METHODS
  We included patients aged 10 to 18 years discharged from one of 38 freestanding children's hospitals participating in a national database from December 1, 2012, to January 5, 2015, with ICD9 codes indicating scoliosis and PSF procedure. Use of ketorolac, gamma aminobutyric acid (GABA) analogues (GABAa), and benzodiazepines was compared across hospitals. Hierarchical logistic regression adjusting for confounders and accounting for clustering of patients within hospitals was used to estimate association between these therapies and odds of prolonged duration of IV opioids, prolonged length of stay (LOS), and early readmissions.
  
  
  RESULTS
  Across hospitals, use of ketorolac and GABAa was highly variable and increased over time among 7349 subjects. Use of ketorolac was independently associated with significantly lower odds of prolonged LOS [odds ratio (OR) 0.75, 95% confidence interval (95% CI) 0.64-0.89] and prolonged duration of IV opioid (OR 0.84, 95% CI 0.73-0.98). GABAa use was significantly associated with decreased odds of prolonged IV opioid use (OR 0.63, 95% CI 0.53-0.75). Readmission rate at 30 days was 1.6% and most strongly associated with prolonged LOS.
  
  
  CONCLUSIONS
  In this national cohort of children with AIS undergoing PSF, patients who received postoperative ketorolac or GABAa were less likely to have prolonged IV opioid exposure. Given the rapid increase in use of adjuvant therapies without strong evidence, resources should be devoted to multicenter trials in order to optimize effectiveness and outcomes.
  
  
  METHODS
  3.
authors: Department of Pediatrics.|NYU School of Medicine; NYU Langone Medical Center.
authors: Rebecca E
authors: RE
authors: Rosenberg
authors: Department of Pediatrics.|NYU School of Medicine; NYU Langone Medical Center.|Hospital for Joint Diseases, New York, NY.
authors: Stacey
authors: S
authors: Trzcinski
authors: Mindy
authors: M
authors: Cohen
authors: Children's Hospital Colorado, Aurora, CO.
authors: Mark
authors: M
authors: Erickson
authors: Department of Orthopedics.|NYU School of Medicine; NYU Langone Medical Center.|Hospital for Joint Diseases, New York, NY.
authors: Thomas
authors: T
authors: Errico
authors: Children's Hospital Colorado, Aurora, CO.
authors: Lisa
authors: L
authors: McLeod
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy*; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D005680:gamma-Aminobutyric Acid; D020910:Ketorolac