General Surgery

DATA ANALYSIS

Harbaugh et al. 2019 (Level 3 evidence)

• DOI: 10.1001/jamasurg.2019.2529
• Included Procedures: Laproscopic Appendectomy
• April 2018 – November 2018
• 59 Patients
• 97% of patients (57/59) were not prescribed or did not use opioids following surgery

SUPPORTING LITERATURE

Kelley-Quon et al. 2022 (Level 2 evidence)

• DOI: http://doi.org/10.1097/XCS.0000000000000056
• Analyzed data from 1,524 children who underwent appendectomy at 10 institutions from January-December 2019.
• Opioid prescribing can be minimized using institutional protocols.
• After intervention, overall prescribing decreased from 18.2% to 4% and mean pain satisfaction scores were high.

Cina et al. 2022 (Level 2 evidence)

• DOI: http://doi.org/10.1016/j.jpedsurg.2022.04.019
• Retrospective study of appendectomy patients (average age 11yo) and opioid prescribing/consumption patterns.
• Analyzed data from 1,789 pediatric patients who underwent an appendectomy at a single institution between January 2014-December 2017.
• Older age, previous opioid exposure, and shorter hospital stay are associated with increased risks of chronic opioid use.

Creamer et al. 2020 (Level 3 evidence)

• DOI: https://doi.org/10.1016/j.jpedsurg.2020.09.067
• Retrospective study of appendectomy patients (median ge of 10yo) and pain scores, opioid exposure, and discharge opioid prescribing habits.
• Analyzed data from 258 pediatric patients who underwent an appendectomy at a single institution between 1 April- 31 December 2018.
• Post-guidelines there was a significant decrease in the number of doses of opioids, length of hospitalization, and days of opioid exposure.
• Number of doses pre-guideline = 0-26.
• Number of doses post-guideline = 0-11.

Manworren et al. 2021 (Level 3 evidence)

• DOI: https://doi.org/10.1016/j.pmn.2021.02.011
• Prospective exploratory and descriptive study of appendectomy patients.
• Analyzed data from 96 pediatric patients (mean age of 14yo) who underwent a laparoscopic appendectomy at a single institution.
• Prescribed 16 ± 6.5 opioid pills to treat pain at home. Patients used 6.6 ± 6.3 pills by pill count but self-reported 5.6 ± 5.1 pills.
• Of the 749 opioid-containing pills prescribed to 49 patients who returned data, 689 pills (92%) were dispensed, 167.5 (22.4%) were used for the reason prescribed, 488 (65.2%) were returned to families for disposal, and 53.5 (7.1%) were missing.

Freedman-Weiss et al., 2020 (Level 2 evidence)

• DOI: 10.1016/j.jpedsurg.2019.09.063
• Patients 5-20 years old who underwent laparoscopic appendectomy.
• 77 patients consented, 49 completed interview. Of these, 7 either wanted opioid or used opioid. Avg MME 3 doses.
• Main outcomes: quantity of opioids used, desire for an opioid, presence of pain ≥ 4/10, and need for follow-up/ call owing to pain.
• 83% did not use or desire an opioid and reported pain < 4/10 after discharge.
• 86% interviewed satisfied without use opioid.
• No zero-opioid patients had unanticipated follow-up for pain concerns.
• Conclusion: recommend acetaminophen and ibuprofen as main form of pain management. If prescribing opioids, consider maximum of 3 doses for population most at risk of uncontrolled pain (male adolescents, those discharged rapidly after surgery, those using inpatient opioids).

DATA ANALYSIS

Harbaugh et al. 2019 (Level 3 evidence)

• DOI: 10.1001/jamasurg.2019.2529
• Included Procedures: Inguinal Herniorrhaphy, Hydrocelectomy
• April 2018 – November 2018
• 84 Patients
• 88% of patients (74/84) were not prescribed or did not use opioids following surgery

SUPPORTING LITERATURE

Chiem et al. 2022 (Level 2 evidence)

• DOI: https://doi.org/10.1097/pq9.0000000000000548
• 641 patients (3yo-18yo) were assigned to study groups based on time period, and were given either standard anesthesia, multimodal anesthesia, or opioid-free anesthesia for inguinal hernia repair. Pain scores were measured.
• Opioids can be safely minimized without sacrificing satisfaction with pain management. Only 12% of patients required a rescue dose of morphine in PACU.

Hageman et al. 2022 (Level 3 evidence)

• DOI: 0.1016/j.jpedsurg.2022.02.039
• Retrospective review of 15 studies were compared with a retrospective review of patients at the authors’ institution. Opioid use was analyzed.
• Opioids were mostly administered while admitted during the first 24h after surgery. One institution uses opioids sparingly in PACU and successfully eliminated opioid prescriptions at discharge.

Svetanoff et al. 2022 (Level 2 evidence)

• DOI: https://doi.org/10.1016/j.jpedsurg.2021.10.012
• Patients were contacted 1-4 weeks after different surgeries and were surveyed about opioid use. Results between procedure types were compared.
• 89% of inguinal hernia patients filled opioid scripts at discharge, and 91% of those opioids went unused. 94% of patients using non-opioid pain relief methods were satisfied with pain management.

DATA ANALYSIS

Harbaugh et al. 2019 (Level 3 evidence)

• DOI: 10.1001/jamasurg.2019.2529 Included Procedures: Umbilical or Epigastric Herniorrhaphy
• April 2018 – November 2018
• 31 Patients
• 97% of patients (30/31) were not prescribed or did not use opioid following surgery

SUPPORTING LITERATURE

Slater et al. 2022 (Level 2 evidence)

• DOI: https://doi.org/10.1016/j.jpedsurg.2021.08.004
• Opioid education was administered to providers, and opioid prescribing data was collected before and after the education was administered.
• There was a significant and sustainable decrease in opioid prescribing (75.8% vs. 22.8% of patients) after administering opioid education to providers.

Harbaugh et al, 2019

• DOI: 10.1001/jamasurg.2019.2529
• 31 patients. 30/31 were not prescribed or did not use opioid.