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Impact of an opioid stewardship program on opioid exposure for pediatric appendectomy postsurgical pain

      Abstract

      Background/purpose

      This study aimed to evaluate the impact of a Pediatric Acute Pain Guideline on postsurgical pain scores, opioid exposure, and discharge opioid prescribing habits in postappendectomy patients.

      Methods

      This was a retrospective single-center quality improvement project, including patients admitted for an appendectomy at a pediatric medical center between April 1 and December 31, 2018. Patients 0–17 years of age, who underwent a laparoscopic appendectomy without complications, were inpatient for at least 1 calendar day, and designated as presurgical American Society of Anesthesiologists (ASA) category 1 or 2 were included.

      Results

      Two hundred fifty-eight patients met inclusion criteria (n = 92 pre-, n = 166 post-guideline implementation). There was a decrease in the number of as needed opioid doses used (p = 0.014) and length of hospitalization (p = 0.003) post-guideline implementation compared to pre-guideline implementation. A decrease in the number of as needed doses of opioids used (p < 0.001) and in opioid exposure (p = 0.038) during hospitalization was also seen when the nonopioid pain agent was scheduled.

      Conclusions

      The implementation of the Pediatric Acute Pain Guideline was associated with a decrease in the number of as needed opioid doses used during hospitalization, which may have contributed to a decreased length of hospitalization. Scheduling nonopioid pain medications decreased opioid exposure.

      Level of evidence

      Treatment study level III.

      Abbreviations:

      American Society of Anesthesiologists (ASA), Center for Disease Control and Prevention (CDC), Institutional Review Board (IRB), Pediatric Intensive Care Unit (PICU), Nonsteroidal anti-inflammatory drug (NSAID)

      Key words

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      References

        • Centers for Disease Control and Prevention
        U.S. opioid prescribing rate maps.
        • National Institute of Health website
        Overdose death rates.
        • Gaither J.R.
        • Shabanova V.
        • Leventhal J.M.
        US national trends in pediatric deaths from prescription and illicit opioids, 1999–2016.
        J Am Med Assoc. 2018; 1https://doi.org/10.1001/jamanetworkopen.2018.6558
        • Kane J.M.
        • Colvin J.D.
        • Bartlett A.H.
        • et al.
        Opioid-related critical care resource use in US children's hospitals.
        Pediatr. 2018; 141https://doi.org/10.1542/peds.2017-3335
        • Chung C.P.
        • Callahan S.T.
        • Cooper W.O.
        • et al.
        Outpatient opioid prescriptions for children and opioid-related adverse events.
        Pediatr. 2018; 142https://doi.org/10.1542/peds.2017-2156
        • McCabe S.E.
        • West B.T.
        • Veliz P.
        • et al.
        Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015.
        Pediatr. 2017; 139https://doi.org/10.1542/peds.2016-2387
        • Reese J.
        • Bielsky A.
        • Wang G.S.
        • et al.
        Clinical pathway: opioid prescribing practices.
        Children's Hospital Colorado, Aurora, CO2017
        • Mitchell A.
        Veldhuyzen van Zanten S, Inglis K, et al. A randomized controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine after outpatient general surgery.
        J Am Coll Surg. 2008; 206: 472-479https://doi.org/10.1016/j.jamcollsurg.2007.09.006
        • Chang A.K.
        • Bijur P.E.
        • Esses D.
        • et al.
        Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial.
        JAMA. 2017; 318: 1661-1667https://doi.org/10.1001/jama.2017.16190
        • Anderson K.T.
        • Bartz-Kurycki M.A.
        • Ferguson D.M.
        • et al.
        Too much of a bad thing: discharge opioid prescriptions in pediatric appendectomy patients.
        J Surg Oncol. 2018; 53: 2374-2377https://doi.org/10.1016/j.jpedsurg.2018.08.034