NEW YORK (Reuters Health) – A quality-improvement initiative significantly reduced opioid prescriptions among children with appendicitis undergoing appendectomy, with no harm to patients.
“We were able to demonstrate that we could minimize opioid prescribing and at the same time still show there was no increase in emergency room visits after surgery or that families were dissatisfied with pain management,” Dr. Lorraine Kelley-Quon, pediatric surgeon at Children’s Hospital Los Angeles, said in a news release.
The study appears in the Journal of the American College of Surgeons.
Appendectomy is the most common surgery in hospitalized children and opioid prescribing varies widely after the surgery. Studies have shown that most children who undergo appendectomy receive “more opioids than are actually necessary,” Dr. Kelley-Quon noted.
The researchers tested a quality improvement (QI) initiative to minimize opioid prescribing at discharge in 1,524 children who had appendectomies at 10 children’s hospitals in the western United States, all members of the Western Pediatric Surgery Research Consortium.
Half of the participating hospitals already had a protocol in place to minimize opioid prescribing after pediatric appendectomy, but the others had no standardized protocol and practice varied among surgeons.
The QI initiative educated healthcare providers about the risks of misuse and abuse related to unused prescription opioids; encouraged use of over-the-counter non-opioid pain medicine, such as acetaminophen and ibuprofen; and engaged families in the child’s post-surgery pain management.
After the QI initiative was implemented, overall opioid prescribing at discharge fell from 18.2% at baseline to 4.0% (P<0.001), a decrease of 78% on average.
In hospitals that didn’t have a prescribing protocol before the QI initiative, opioid prescribing dropped 77% – from 37.9% before implementation to 8.8% after (P<0.001).
Even hospitals that had a protocol in place saw a 70% reduction in opioid prescribing, from 2.7% before to 0.8% after the QI initiative (P=0.003).
Emergency-department visits were essentially unchanged after the QI program, at 8.9% before versus 9.9% after (P=0.54), and there was no decrease in patient satisfaction.
Dr. Kelley-Quon said use of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric platform was key to implementing the QI intervention.
“NSQIP has really helped surgeons see how an individual hospital can compare itself with other hospitals in the country. What our project did was take that one step farther to enable a group of hospitals to use the platform in real time to really change practice for a specific quality improvement initiative across several hospitals at once,” she said in the news release.
SOURCE: https://bit.ly/34C6fF5 Journal of the American College of Surgeons, online February 3, 2022.
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