Surgeon feedback to decrease opioid prescriptions after pediatric appendectomy

Once the treatment team has decided to pursue surgery, laparoscopic appendectomy is the predominant approach with open appendectomy being performed much less frequently than in the past.4 With advances in minimally invasive surgery, there have been fewer postoperative analgesic requirements with the ability to now avoid narcotics entirely in procedures, such as laparoscopic appendectomy.5 Multimodal pain strategies have been well described within the adult and pediatric literature for postoperative pain control with an emphasis on minimizing or altogether avoiding narcotics. Data points included patient characteristics, diagnostic imaging patterns, treatment modalities, and, most pertinent for this study, opioid prescribing habits from each site. By the final third, the average dose at discharge was 0.87 doses, and 14.8% of patients received narcotics at the time of discharge (table 1).Table 1 Comparison of average narcotic dosing and rate of opioid prescriptions at discharge Metric Control (n=491) Intervention (n=160) P value First 1/3 of intervention (n=55) Last 1/3 of intervention (n=54) P value first 1/3 vs last 1/3 (non-parametric) Average number of doses per total 9.68±11.71 2.61±6.11 0.0001 3.33±7.57 0.87±2.2 0.0241 Count of patients prescribed narcotics at discharge (%) 322 (65.6%) 37 (23.1%) 0.0001 15 (27.3%) 8 (14.8%) 0.111 *Continuous variables reported above with use of unpaired t-test for statistical analysis. Cairo et al recently showed that educational interventions and a standard opioid protocol in children after laparoscopic appendectomy resulted in a significant decrease in opioid prescriptions without an increase in emergency department visits or phone calls, with 94% of patients stating they had adequate pain