Multi-Institutional Quality Improvement Project to Minimize Opioid Prescribing in Children after Appendectomy Using...

Area of Science:

• Pediatric Surgery
• Quality Improvement Science
• Pain Management

Background:

• Wide variation exists in pediatric opioid prescribing post-appendectomy.
• Increasing rates of pediatric deaths linked to opioid use highlight the need for intervention.
• Quality Improvement (QI) methodology was employed to address this issue.

Purpose of the Study:

• To minimize opioid prescribing at discharge for children undergoing appendectomy.
• To implement and evaluate a multi-institutional QI project focused on reducing pediatric opioid prescriptions.

Main Methods:

• A prospective, multi-institutional QI project was conducted across 10 children's hospitals.
• Data from 1,524 children undergoing appendectomy from January to December 2019 were analyzed.
• Opioid prescribing rates before and after the QI intervention were compared using chi-square analysis.

Main Results:

• Overall opioid prescribing at discharge decreased from 18.2% to 4.0% post-intervention (p < 0.001).
• Significant reductions were observed in both protocol (2.7% to 0.8%) and no-protocol (37.9% to 8.8%) hospitals.
• Emergency room visits and patient satisfaction scores remained stable.

Conclusions:

• Opioid prescribing after pediatric appendectomy can be effectively minimized without adverse effects on ER visits or patient satisfaction.
• The NSQIP-Pediatric database serves as a valuable platform for multi-institutional QI collaborations.
• QI initiatives are crucial for optimizing pain management and reducing opioid-related risks in pediatric surgery.