A multi-institutional approach for decreasing narcotic prescriptions after laparoscopic appendectomy

Area of Science:

• Surgical Quality Improvement
• Pain Management
• Public Health

Background:

• Appendicitis is a frequent surgical admission, often treated with laparoscopic appendectomy.
• Postoperative pain control for appendectomy varies widely in narcotic utilization.
• The opioid epidemic necessitates reducing the circulation of prescription narcotics.

Purpose of the Study:

• To decrease outpatient narcotic use in adults after laparoscopic appendectomy.
• To evaluate the impact of a multimodal analgesia strategy and feedback reports on narcotic prescribing habits.
• To hypothesize a reduction, or elimination, of outpatient narcotic prescriptions.

Main Methods:

• A quality improvement project provided monthly feedback on narcotic prescribing habits to surgeons.
• A multi-hospital database tracked adult laparoscopic appendectomy patients and discharge narcotic doses.
• A protocol for perioperative pain management was distributed, with data from the preceding year used as a control.

Main Results:

• The average number of prescribed narcotics decreased by 40% (from 23.6 to 14.2 doses) post-intervention (p < 0.001).
• No significant change was observed in the total number of narcotic prescriptions (8.9% vs. 7.9%, p = 0.52).
• Both local and distant hospitals showed decreased narcotic prescribing, with local sites demonstrating an immediate reduction.

Conclusions:

• A multimodal pain regimen coupled with monthly narcotic prescription reports significantly reduces the average number of prescribed narcotics post-laparoscopic appendectomy.
• This strategy effectively decreases outpatient narcotic utilization.
• Local sites achieved quicker reductions in narcotic use compared to distant sites.