A Quality Improvement Intervention to Decrease Postoperative Opioid Prescriptions in Pediatric Oncology Patients

Area of Science:

• Pediatric Surgery
• Oncology
• Pain Management
• Quality Improvement

Background:

• Opioid prescribing after pediatric surgery, particularly in oncology patients, presents challenges in pain management.
• Minimizing opioid use is crucial to mitigate risks associated with these medications in pediatric populations.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative aimed at reducing opioid prescribing following oncologic pediatric surgery.
• To assess the impact of this initiative on pain control, patient satisfaction, and unplanned healthcare utilization.

Main Methods:

• A retrospective review of surgical data (July 2016-June 2018) was conducted, followed by a prospective data collection after initiative implementation (July 2018 onwards).
• Key metrics included opioid dosage (oral morphine equivalents), pain-related unplanned visits/calls, and patient/parent satisfaction.
• The initiative involved promoting non-opioid analgesia and standardized opioid discharge protocols based on inpatient needs.

Main Results:

• The prospective cohort (99 patients) showed a significant reduction in mean opioid discharge prescriptions (0.75 mg/kg) compared to the retrospective cohort (5.48 mg/kg, P<0.001).
• Unplanned pain-related visits/calls decreased from 8.5% to 2.0%.
• Opioid prescription rates at discharge dropped significantly (92.6% to 44.4%, P<0.001), with reduced dispensed doses used, while length of stay remained comparable.

Conclusions:

• A quality improvement initiative can dramatically reduce opioid prescriptions after pediatric oncologic surgery.
• This reduction can be achieved without compromising patient satisfaction or increasing readmissions.
• The findings support the adoption of opioid-sparing strategies in pediatric surgical oncology pain management.