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Reducing opioid utilization after appendectomy: A lesson in implementation of a multidisciplinary quality improvement

Kimberly K Somers1, Ruchi Amin1, Kathleen M Leack1

  • 1Children's Hospital of Wisconsin and Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.

Surgery Open Science
|August 6, 2020
PubMed

Insights

A quality improvement project successfully reduced opioid use in children after laparoscopic appendectomy. Implementing ice packs, standardized pain scores, and a new order set decreased overall opioid consumption.

Area of Science:

  • Pediatric Surgery
  • Pain Management
  • Quality Improvement

Background:

  • Perioperative pain management after appendectomy can be a child's initial exposure to opioids.
  • Assessing and refining pain medication prescribing practices is crucial for reducing unnecessary opioid use.

Purpose of the Study:

  • To decrease unnecessary opioid use in pediatric patients undergoing laparoscopic appendectomy.
  • To implement simple, targeted interventions to improve perioperative pain management.

Main Methods:

  • A quality improvement project involving three key measures: ice packs, standardized pain scores, and a revised postoperative order set.
  • Comparison of pre- and postimplementation opioid utilization in patients undergoing laparoscopic appendectomy for acute appendicitis.

Main Results:

  • Statistically significant decreases in intravenous and enteral opioid administration were observed postimplementation.
  • The number of opioid doses prescribed at discharge and the proportion of patients discharged with opioids were significantly reduced.
  • High compliance rates were achieved for the implemented measures: ice packs (66.9%), pain scores (88%), and postoperative order set (94.7%).

Conclusions:

  • A multidisciplinary approach assessing expectations and current practices effectively reduced overall opioid consumption.
  • Targeted interventions can significantly improve perioperative pain management and decrease opioid reliance in pediatric appendectomy patients.
Abstract

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