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Impact of an opioid stewardship program on opioid exposure for pediatric appendectomy postsurgical pain
Mackenzie Creamer1, Heidi Trinkman1, Tyler Hamby1
1Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104.
Insights
Implementing a pediatric acute pain guideline reduced opioid use and hospitalization length for appendectomy patients. Scheduling nonopioid pain medications further decreased opioid exposure during recovery.
Area of Science:
- Pediatric Surgery
- Pain Management
- Quality Improvement
Background:
- Appendectomy is a common pediatric surgical procedure.
- Effective postsurgical pain management is crucial for recovery.
- Opioid use in pediatric patients requires careful consideration due to potential risks.
Purpose of the Study:
- To evaluate the impact of a new Pediatric Acute Pain Guideline.
- Assess changes in postsurgical pain scores, opioid exposure, and discharge prescribing.
- Analyze outcomes in postappendectomy patients.
Main Methods:
- Retrospective single-center quality improvement project.
- Included pediatric patients (0-17 years) undergoing laparoscopic appendectomy.
- Compared outcomes pre- and post-guideline implementation.
Main Results:
- Reduced number of as needed opioid doses used post-guideline (p=0.014).
- Decreased length of hospitalization post-guideline (p=0.003).
- Scheduled nonopioid pain agents correlated with decreased opioid exposure (p<0.001).
Conclusions:
- Pediatric Acute Pain Guideline implementation reduced opioid consumption during hospitalization.
- Reduced opioid use may contribute to shorter hospital stays.
- Proactive scheduling of nonopioid analgesics effectively lowers opioid exposure.
Background/Purpose:
This study aimed to evaluate the impact of a Pediatric Acute Pain Guideline on postsurgical pain scores, opioid exposure, and discharge opioid prescribing habits in postappendectomy patients.
Methods:
This was a retrospective single-center quality improvement project, including patients admitted for an appendectomy at a pediatric medical center between April 1 and December 31, 2018. Patients 0-17 years of age, who underwent a laparoscopic appendectomy without complications, were inpatient for at least 1 calendar day, and designated as presurgical American Society of Anesthesiologists (ASA) category 1 or 2 were included.
Results:
Two hundred fifty-eight patients met inclusion criteria (n = 92 pre-, n = 166 post-guideline implementation). There was a decrease in the number of as needed opioid doses used (p = 0.014) and length of hospitalization (p = 0.003) post-guideline implementation compared to pre-guideline implementation. A decrease in the number of as needed doses of opioids used (p < 0.001) and in opioid exposure (p = 0.038) during hospitalization was also seen when the nonopioid pain agent was scheduled.
Conclusions:
The implementation of the Pediatric Acute Pain Guideline was associated with a decrease in the number of as needed opioid doses used during hospitalization, which may have contributed to a decreased length of hospitalization. Scheduling nonopioid pain medications decreased opioid exposure.
Level Of Evidence:
Treatment study level III.
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