Variation in postoperative narcotic prescribing after pediatric appendectomy

Area of Science:

• Pediatric Surgery
• Pain Management
• Public Health

Background:

• Opioid overuse is a significant public health concern in both pediatric and adult populations.
• Educational interventions have successfully reduced postoperative opioid use in adults, but data in pediatrics were lacking.

Purpose of the Study:

• To evaluate the impact of educational interventions on opioid prescribing practices in pediatric patients undergoing appendectomy.
• To assess the effectiveness of non-opioid analgesia and patient satisfaction post-intervention.

Main Methods:

• Implementation of staff education, an opioid standardization protocol, and patient/family educational materials.
• Retrospective chart review comparing opioid prescribing before and after the intervention for patients under 19 years old.
• Follow-up phone calls to assess patient-reported pain control and satisfaction.

Main Results:

• Opioid prescriptions at discharge decreased from 84.3% pre-intervention to 6.7% post-intervention (p < 0.001).
• There was a significant increase in the use of non-opioid analgesics (p < 0.001) post-intervention.
• 94.4% of patients reported adequate pain control, and 88.9% would avoid opioids in the future, with no increase in emergency department visits for pain.

Conclusions:

• Low-fidelity educational interventions and standardized pathways effectively reduce pediatric opioid prescribing.
• Alternative analgesia, such as acetaminophen and ibuprofen, can provide adequate pain control post-appendectomy.
• These interventions promote safer pain management strategies without compromising patient outcomes or increasing healthcare utilization.