Surgeon feedback to decrease opioid prescriptions after pediatric appendectomy

Appendicitis is one of the most common indications for hospital admission and surgery within the pediatric population.1 Approximately 70 000 appendectomies are performed annually, and the incidence is on the rise.2 3 The initial decision point in treatment consists of operative versus non-operative management. Once the treatment team has decided to pursue surgery, laparoscopic appendectomy is the predominant approach with open appendectomy being performed much less frequently than in the past.4 With advances in minimally invasive surgery, there have been fewer postoperative analgesic requirements with the ability to now avoid narcotics entirely in procedures, such as laparoscopic appendectomy.5 Multimodal pain strategies have been well described within the adult and pediatric literature for postoperative pain control with an emphasis on minimizing or altogether avoiding narcotics. However, on discharge, patients are still often prescribed an opioid out of a desire to combat the "fifth vital sign": pain. Unfortunately, the unintended consequence of narcotic utilization has been a physician-enabled epidemic of addiction and overdose. This study was designed to test the hypothesis that a standardized, multimodal pain regimen combined with monthly reports detailing prescribing habits would significantly decrease the number of opioids prescribed at the time of discharge.