Opioid and sedative-amnestic medications are vital immediately after congenital heart surgery to reduce pain and anxiety, reduce metabolic demand, and maintain stability in these critically ill patients. However, prolonged exposure to these agents may have deleterious effects on vulnerable infants’ development. As a result, an increased understanding of these trends would address a knowledge gap that might help guide future quality improvement and research efforts to determine the optimal care of these patients. The first aim of our project is to characterize the exposure of infants (<1 year) undergoing open-heart surgeries for acquired and congenital heart disease to opioids, benzodiazepine, and adjuvant agents. Our first hypothesis is “There will be significant variation in the total exposure to opioids and benzodiazepines between hospitals even after adjusting for case mix” while our second hypothesis is “The likelihood of receiving antipsychotics, ketorolac, and other non-opioid and benzodiazepine medications will also vary significantly between centers” . Our second aim for the project is to characterize trends in the exposure of infants (<1 year) undergoing open-heart surgeries for acquired and congenital heart disease in which our hypothesis states that ”After adjusting for case mix the total exposure to opioid and benzodiazepine will have increased across the study period (2011-2021).” 

We were able to look at input data from PHIS, a comparative pediatric database, that includes clinical and resource utilization data for inpatient, ambulatory surgery, Emergency Department, and observation unit patient encounters for 45 children's hospitals. Data about patient abstract, diagnoses (ICD-9/10), procedures, billed transactions and utilization were extracted from PHIS and the patient types included inpatient, observation, ambulatory surgery and ED. 

One of the outcomes we hope to look at is cumulative total exposure to opioids and/or sedative amnestics. If dosages are available this will be expressed as a morphine equivalent or diazepam equivalent but if not, total days of exposure will be used. We also plan on looking at daily exposure as a secondary outcome in which we will use total exposure/days to opioid and sedative/amnetics. Lastly, we will look at exposure to Gabapentin, Antipsychotics, Ketorolac , IV Tylenol , Tylenol and NSAID.  

We are currently in the process of data extraction and analysis.