Evidence map›Paper›PMID 37747042›Full record

ReviewOtolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery2024

Reducing Pediatric Posttonsillectomy Opioid Prescribing: A Quality Improvement Initiative.

Shaunak N Amin, Trey Thompson, Xing Wang, Samantha Goldklang, Lynn D Martin, Daniel K-W Low, Sanjay R Parikh, Kathleen C Sie, John P Dahl

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Shaunak N AminDepartment of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.ORCID 0000-0001-7947-4724
Trey ThompsonDepartment of Surgery, University of Washington, Seattle, Washington, USA.
Xing WangDepartment of Biostatistics, Seattle Children's Research Institute, Seattle, Washington, USA.
Samantha GoldklangDivision of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.
Lynn D MartinDepartment of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
Daniel K-W LowDepartment of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
Sanjay R ParikhDepartment of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Kathleen C SieDepartment of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
John P DahlDepartment of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.

Funding

Research Training in OtolaryngologyT32DC000018 · NIDCD · UNIVERSITY OF WASHINGTON · PI STONE, JENNIFER S. · 1989 to 2023
$7.8M
NIDCD NIH HHS T32 DC000018
6 · The paper itself

Abstract

objectivePostoperative pain is the most common morbidity associated with tonsillectomy. Opioids are frequently used in multimodal posttonsillectomy analgesia regimens; however, concerns regarding respiratory depression, drug-drug interactions, and medication misuse necessitate responsible opioid stewardship among prescribing surgeons. It is unclear if intentionally reducing opioid prescription doses negatively affects the patient experience.

methodsA quality improvement team reviewed all posttonsillectomy opioid prescriptions at a pediatric ambulatory surgery center between January and June 2021 (preintervention, 163 patients). Following this review, we performed an opioid education session for surgeons and studied opioid prescribing habits between July and December 2021 (Plan-Do-Study-Act [PDSA] 1, 152 patients). We then implemented a standardized prescription protocol of 7 doses of oxycodone per patient and again reviewed prescriptions between January and June 2022 (PDSA 2, 178 patients). The following measures were evaluated: initial number of opioid doses prescribed, need for refills, 7-day emergency department (ED) visits, and readmissions.

resultsEach intervention reduced the average number of initial oxycodone doses per patient (12.2 vs 9.2 vs 6.9 doses, P < .001). There were no changes in the rate of refill requests, 7-day ED visits, and readmissions, by descriptive or Statistical Process Control analyses. DISCUSSION: In 2 PDSA cycles, we achieved a 43% reduction in the number of doses of oxycodone prescribed following tonsillectomy. We did not observe any increased rates in balancing measures, which are surrogates for unintentional effects of PDSA changes, including refills, ED presentations, and readmission rates. IMPLICATIONS FOR PRACTICE: Directed provider education and standardized posttonsillectomy prescription protocols can safely decrease postoperative opioid prescribing. Further PDSA cycles are required to consider even fewer opioid prescription doses.

Indexed as

Analgesics, OpioidOxycodoneChildHumansPostoperative PainPractice Patterns, Physicians'Quality ImprovementAnalgesics, OpioidOxycodoneopioidspediatric otolaryngologyPS/QIsleep apnea/snoringtonsillectomy

Identifiers

PMID37747042
PMCPMC10841103

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.