Opioid-free Laparoscopic Appendectomy: Quality Improvement Project

Introduction: This quality improvement project has tracked postoperative measures for more than 5 years as we implement an opioid-free laparoscopic appendectomy protocol. Methods: We used statistical process control charts to analyze real-world data captured from the medical record. Outcome measures included postanesthesia care unit (PACU) length of stay (LOS), 24-hour maximum pain scores, PACU intravenous opioid medication administration, hospital LOS, and postoperative day 1 morphine milliequivalent requirement. We monitored this family of measures in all appendectomy patients as our team adopted the opioid-free protocol; in addition, we rationally subgrouped patients into the opioid-receiving group versus the opioid-free group. Results: A total of 2,483 pediatric laparoscopic appendectomies were performed between January 1, 2017, and June 30, 2023. Starting in 2017, we encouraged anesthesia providers to follow an opioid-free protocol for laparoscopic appendectomy. By October 2019, a similar to 50% adoption rate of intraoperative opioid-free anesthetic management had occurred. In total, 1,486 patients received opioids and 997 patients did not (opioid-free). No special cause variation was observed for the measured outcomes, including maximum 24-hour pain scores or PACU rescue opioid administration. We did notice reduced hospital LOS in addition to a reduced postoperative day 1 morphine milliequivalent requirement in the opioid-free group. Conclusions: This quality improvement project implemented an opioid-free laparoscopic appendectomy protocol for pediatric patients without adversely affecting pain scores, rate of PACU rescue opioids, or hospital LOS.