Variation in postoperative narcotic prescribing after pediatric appendectomy.
BACKGROUND
Overuse of prescription opioids by both pediatric and adult patients has garnered significant attention in recent years. Educational interventions have been shown to decrease prescription opioids post-operatively in the adult population; similar data have not previously been reported in pediatrics.


METHODS
Educational interventions included staff education, institution of opioid standardization protocol, and distribution of educational materials to families. Chart review was performed pre- and post-intervention to compare prescribing practices following appendectomy in patients less than 19 years of age. Follow-up phone calls were used to assess patient satisfaction and pain control.


RESULTS
Three hundred thirteen cases were identified pre-intervention [PRE] and compared to 119 cases postintervention [POST]. 84.3% of patients were given a prescription for opioids at time of discharge in the PRE cohort compared to 6.7% (p < 0.001) POST. There was a significant increase in non-opioid analgesia (p < 0.001) POST. There was no significant variability in opioid usage by type of surgery performed, attending provider, or patients' gender or age. Of the patients in the POST cohort, 60.5% were available for telephone follow-up. More than 80% of patients were given acetaminophen and/or ibuprofen POST and 94.4% reported adequate pain control; 88.9% reported that they would agree to avoid opioids again in the future. On follow-up survey, there was no increase in emergency department visits or phone calls for poorly controlled pain following the intervention.


CONCLUSION
Low-fidelity educational interventions and creation of a standardized pathway is an effective tool to reduce opioid prescribing and promote alternative means of analgesia without an increase in readmissions or presentation for pain.


LEVEL OF EVIDENCE
III.
['Cairo|Sarah B|SB|', 'Calabro|Kristen A|KA|', 'Bowdish|Elizabeth|E|', 'Reilly|Cara|C|', 'Watt|Stacey|S|', 'Rothstein|David H|DH|']
D000293:Adolescent D001062:Appendectomy D002648:Child D002675:Child, Preschool D011307:Drug Prescriptions D006801:Humans D007223:Infant D007231:Infant, Newborn D009294:Narcotics D010149:Pain, Postoperative D010818:Practice Patterns, Physicians'
Adolescent surgery Opioid epidemic Opioid use Pediatric surgery Postoperative pain control