Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real-world data.

IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pediatric Anesthesia Pub Date : 2024-11-01 Epub Date: 2024-08-30 DOI:10.1111/pan.14979
Jennifer L Chiem, Amber M Franz, Elizabeth E Hansen, Shilpa T Verma, Taylor F Stanzione, Leah K Bezzo, Michael J Richards, Sanjay R Parikh, John P Dahl, Daniel K Low, Lynn D Martin
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Abstract

Introduction: This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan-Do-Study-Act cycles.

Methods: From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure-specific perioperative Plan-Do-Study-Act cycles, three procedure-specific postoperative prescription Plan-Do-Study-Act cycles, and four general ambulatory surgical center enhanced recovery Plan-Do-Study-Act cycles. We analyzed data from the medical record using statistical process control charts. The primary outcome measure was the percent of patients requiring intravenous opioid in the post anesthesia care unit. Secondary outcomes included maximum post anesthesia care unit pain score, the percent of patients requiring treatment for nausea and/or vomiting in the post anesthesia care unit, and the number of postoperative opioid prescription dosages. Balancing measures were average post anesthesia care unit length of stay, percent of patients with prolonged Post Anesthesia Care Unit length of stay (>120 min), and 30-day reoperation rate.

Results: A total of 5654 tonsillectomy with or without adenoidectomy cases were performed at our ambulatory surgical center from 2015 to 2023. The incidence of intravenous opioid administered in the post anesthesia care unit initially rose with opioid free anesthesia launch, but subsequently decreased below the target of 10%. Maximum post anesthesia care unit pain scores rose from mean 3.6 to 4.5, but subsequently returned to the baseline of 3.5, while the incidence of postoperative nausea and/or vomiting improved. The average post anesthesia care unit length of stay increased by 10 min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30-day reoperation rates were unchanged.

Conclusions: The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay.

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采用阿片类药物稀释麻醉方案优化小儿扁桃体切除术的疗效:从真实世界的数据中学习并不断改进。
导言:这项质量改进计划旨在通过数据驱动的 "计划-实施-研究-行动"(Plan-Do-Study-Act)周期,不断改进儿科门诊手术中心扁桃体切除术(带或不带腺样体切除术)的阿片类药物稀释麻醉方案,从而优化手术效果:从 2015 年 1 月 1 日到 2023 年 12 月 12 日,我们的标准化扁桃体切除术方案经历了 9 个特定手术围手术期的 Plan-Do-Study-Act 循环、3 个特定手术术后处方的 Plan-Do-Study-Act 循环和 4 个普通门诊手术中心增强恢复的 Plan-Do-Study-Act 循环。我们使用统计过程控制图分析了病历中的数据。主要结果是需要在麻醉后护理病房静脉注射阿片类药物的患者比例。次要结果包括麻醉后护理单元的最大疼痛评分、需要在麻醉后护理单元接受恶心和/或呕吐治疗的患者百分比以及术后阿片类药物处方剂量的数量。平衡指标包括麻醉后护理病房平均住院时间、麻醉后护理病房住院时间过长(>120 分钟)患者的百分比以及 30 天再手术率:从2015年到2023年,我们的非卧床手术中心共进行了5654例扁桃体切除术合并或不合并腺样体切除术。麻醉后护理单元静脉注射阿片类药物的发生率最初随着无阿片类药物麻醉的启动而上升,但随后下降到10%的目标值以下。麻醉后护理单元的最大疼痛评分从平均 3.6 分上升到 4.5 分,但随后又恢复到 3.5 分的基线,而术后恶心和/或呕吐的发生率则有所改善。不使用阿片类药物麻醉后,麻醉后护理单元的平均住院时间增加了10分钟;但是,麻醉后护理单元的长期住院时间和30天再手术率没有变化:结论:通过不断改进我们的阿片类药物稀释麻醉方案,围手术期和家庭阿片类药物的使用量减少了,麻醉后护理单元的最大疼痛评分稳定了,术后恶心和呕吐率提高了,而麻醉后护理单元的平均住院时间仅略有增加。
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来源期刊
Pediatric Anesthesia
Pediatric Anesthesia 医学-麻醉学
CiteScore
3.20
自引率
11.80%
发文量
222
审稿时长
3-8 weeks
期刊介绍: Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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