New England Surgical Society

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The effectiveness of an intervention to decrease postoperative opiate prescriptions
David P Mooney, *Lee Ranstrom
Boston Children's Hospital, Boston, MA

Objective: Opiates were the mainstay for postoperative pain. Complications related to Codeine metabolism led many children’s hospitals to Oxycodone as their routine opiate. Increased opiate availability is associated with increased addiction.
Design: Children who underwent acute laparoscopic appendectomy from 7/2012 to 2/2013 were identified opiate prescriptions and how many were filled was determined. A plan to limit opiates was developed and narcotic prescription from 12/2016 to 12/2017 was determined. A plan to eliminate opiates was developed and narcotic prescription from 01/2018 to 12/2018 was determined.
Setting: Children’s hospital.
Patients: Children undergoing a acute laparoscopic appendectomy.
Interventions: Opiate-limited discharge plans.
Main Outcome Measures: Narcotics prescribed.
Results: 75 children who underwent appendectomy received opiate prescriptions (average 60.2 mg) per patient. After first intervention 208 children underwent appendectomy and received opiate prescriptions (6.8 mg per patient) and 14% of patients took prescribed opiates. After the second intervention 270 patients underwent appendectomy and 3 patients (1.1%) received opiate prescriptions (0.25 mg per patient). 45% of patients were contacted by phone and no pain issues were identified.
Conclusions: Using a step-wise process we eliminated the use of opiates for post-discharge pain in children undergoing acute laparoscopic appendectomy.

Opiate Use after Appendectomy
Pre-InterventionFirst InterventionSecond Intervention
Time Period2012-132016-172018-19
Patients (number)75208270
Opiates (mg)4514141270
Opiates (mg/patient)

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