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Multi-Institutional Quality Improvement Project to Minimize Opioid Prescribing in Children after Appendectomy Using
Lorraine I Kelley-Quon1,2, Shadassa Ourshalimian1, Justin Lee3
1From the Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Kelley-Quon, Ourhsalimian, Wang).
Insights
Opioid prescribing after pediatric appendectomy was significantly reduced using a Quality Improvement (QI) initiative. This successful strategy minimized opioid use without impacting emergency room visits or patient satisfaction.
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.
Background:
There is wide variation in opioid prescribing after appendectomy in children and adolescents, with recent increases noted in opioid-related pediatric deaths from prescription and illicit opioids. The goal of this project was to minimize opioid prescribing at the time of discharge for children undergoing appendectomy by using Quality Improvement (QI) methodology.
Study Design:
Children (18 years of age or less) who underwent appendectomy were evaluated from January to December 2019 using NSQIP-Pediatric at 10 children's hospitals within the Western Pediatric Surgery Research Consortium. Before project initiation, 5 hospitals did not routinely prescribe opioids after appendectomy (protocol). At the remaining 5 hospitals, prescribing was not standardized and varied by surgeon (no-protocol). A prospective multi-institutional QI project was used to minimize outpatient opioid prescriptions for children after appendectomy. The proportion of children at each hospital receiving an opioid prescription at discharge was compared for 6 months before and after the intervention using chi-square analysis.
Results:
Overall, 1,524 children who underwent appendectomy were evaluated from January to December 2019. After the QI intervention, overall opioid prescribing decreased from 18.2% to 4.0% (p < 0.001), with significant decreases in protocol hospitals (2.7% vs 0.8%, p = 0.038) and no-protocol hospitals (37.9% vs 8.8%, p < 0.001). The proportion of 30-day emergency room visits did not change after the QI intervention (8.9% vs 9.9%, p = 0.54) and mean postintervention pain management satisfaction scores were high.
Conclusion:
Opioid prescribing can be minimized in children after appendectomy without increasing emergency room visits or decreasing patient satisfaction. Furthermore, NSQIP-Pediatric can be used as a platform for multi-institutional collaboration for successful implementation of QI projects.
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