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Opioid-free Laparoscopic Appendectomy: Quality Improvement Project.

Kelsey Mitchell¹, Hilary Hoffman¹, David E Liston¹

¹From the Anesthesiology and Pain Medicine, University of Washington-Seattle Children's Hospital, Seattle, Wash.

Pediatric Quality & Safety

|February 21, 2025

Summary

Implementing an opioid-free laparoscopic appendectomy protocol for pediatric patients did not negatively impact pain scores or hospital stays. This approach successfully reduced hospital length of stay and postoperative opioid use.

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Area of Science:

Pediatric Surgery
Anesthesiology
Quality Improvement

Background:

The implementation of an opioid-free laparoscopic appendectomy protocol was tracked over five years.
This initiative aimed to assess postoperative outcomes following the protocol's adoption.

Purpose of the Study:

To evaluate the effectiveness of an opioid-free laparoscopic appendectomy protocol in pediatric patients.
To determine the impact on key postoperative measures including pain, opioid administration, and length of stay.

Main Methods:

Utilized statistical process control charts to analyze real-world data from medical records.
Monitored outcomes such as postanesthesia care unit (PACU) length of stay (LOS), 24-hour pain scores, PACU opioid administration, hospital LOS, and postoperative day 1 opioid requirements.
Subgrouped patients into opioid-receiving and opioid-free groups for comparative analysis.

Main Results:

A total of 2,483 pediatric laparoscopic appendectomies were analyzed.
No significant variation was observed in maximum 24-hour pain scores or PACU rescue opioid administration.
The opioid-free group demonstrated a reduced hospital LOS and a lower postoperative day 1 morphine milliequivalent requirement.

Conclusions:

The opioid-free laparoscopic appendectomy protocol was successfully implemented in pediatric patients.
The protocol did not adversely affect pain scores, PACU rescue opioid rates, or hospital LOS.
This quality improvement project highlights the feasibility and benefits of opioid-free appendectomies.