Decreasing Opioid Usage in Pediatric Cholecystectomy Through Care Standardization: A Quality Improvement Project...

Area of Science:

• Pediatric Surgery
• Quality Improvement
• Anesthesiology

Background:

• Enhanced recovery after surgery (ERAS) protocols are established in adult surgical care but less documented in pediatric populations.
• Variable perioperative management previously led to inconsistent opioid use in pediatric laparoscopic cholecystectomy.

Purpose of the Study:

• To reduce opioid use by 25% in pediatric laparoscopic cholecystectomy patients using an ERAS protocol.
• To evaluate the impact of ERAS on pain scores, nausea/vomiting, pruritus, and hospital length of stay.

Main Methods:

• A quality improvement project implemented an ERAS protocol at a pediatric academic hospital.
• A multidisciplinary team standardized perioperative care using electronic medical record advisories, education, and stakeholder engagement.

Main Results:

• Opioid use (morphine milligram equivalents) decreased by 27% over 32 months.
• Mean pain scores, postoperative nausea/vomiting, pruritus, and hospital length of stay showed no significant increase.
• The 30-day readmission rate remained stable.

Conclusions:

• Standardized ERAS protocols effectively reduce opioid consumption in pediatric laparoscopic cholecystectomy.
• ERAS implementation is safe and does not adversely affect key patient outcomes like pain or length of stay.