Available online 18 May 2024

: The aim of this quality improvement (QI) project was to assess postoperative narcotic use after pediatric gynecologic surgeries and establish standard postoperative opioid dosing. Through standard dosing we hoped to decrease variability in postoperative opioid prescriptions and decrease excess opioid doses in the community.

: This QI project was approved by the Children's Minnesota IRB. Counseling on postoperative pain management was provided pre- and post-operatively. At the two-week postoperative visit, patients were asked the number of opioid doses used and pain control satisfaction. Baseline data was collected for 6 months with surgeons prescribing the number of opioid doses based on their personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established, and data collection repeated.

: Complete data was recorded for 30 cases prior to implementation of standard doses and for 29 cases following implementation. Standardized opioid dosing resulted in 30% decrease in total opioid doses in circulation (252→176 doses; P=0.014) and 15% reduction in excess doses in circulation (162→137 doses). Forty-three percent of patients did not use any opioid doses. There was no significant difference P=0.8818) in patient pain control satisfaction rating.

: Standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient pain control satisfaction. Opioid dose standardization may decrease opioid circulation within the community. Approximately 2 out of every 5 patients used zero opioid doses which suggests further reduction in the standard dose prescriptions is possible.

While there are many causes for increased opioid use and the resulting opioid epidemic, excessive postoperative provision of narcotics is a known contributing factor.1 Increasing data confirms over prescription of narcotic medication in adult gynecologic surgery, but similar assessments have not been addressed in the pediatric gynecologic literature.2 Narcotic overprescribing among minors has been linked to increase risk of opioid misuse in adulthood. Postoperative narcotic use is a known risk

This QI project was approved by the Children's Minnesota Institutional Review Board. The first step of the project was to assess how many opioid doses our patients were using and create standard doses based on the information gathered.

Inclusion in data analysis for this project included all patients receiving a gynecologic laparoscopy, laparotomy, vaginal or combined (laparoscopic and vaginal) surgery by one of three fellowship-trained gynecologic surgeons. Exclusion criteria included surgical

Complete data was recorded for 30 cases prior to implementation (3 laparotomies with incision >4cm, 19 laparoscopy/mini-laparotomy with total length of incision(s) ≤4cm, 3 combined vaginal/laparoscopy and 5 vaginal). Complete data was recorded for 29 cases following implementation (5 laparotomies with incision >4cm, 19 laparoscopy/mini-laparotomy with total length of incision(s) ≤ 4cm, 5 combined vaginal/laparoscopy, and 2 vaginal). Missing data occurred in 2 patients prior to implementation

In our QI project, prescribing fewer opiate doses resulted in patient use of fewer doses. This is similar to data found by Sherrer, et al in the study titled “A Prospective Analysis of Opioid Use Following Outpatient Pediatric Urologic Surgery.”5 The mere availability of more opioids may contribute to a patient's willingness to use more. Conversely, patients may be more judicious with opioids if fewer doses are available. Patients may perceive provision of fewer opioids with a surgeon's

The authors of this paper have nothing to disclose.

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© 2024 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.