(120) Opioid Sparing Post-Tonsillectomy Care: A Quality Improvement Project

Introduction: Opioid prescribing practices following pediatric outpatient adenotonsillectomy have been variable. We hypothesize that children on an opioid sparing protocol would report similar post-operative pain compared to children prescribed opioids following outpatient pediatric adenotonsillectomy.

Methods: A new opioid sparing protocol was implemented for children who were 3 – 18 years old who underwent adenotonsillectomy at a pediatric ambulatory surgery center. Previously, the practice was to allow for up to 7 doses of opioids post-operatively. The new protocol recommended children 5 years and under not receive opioids. Children >6 years given opioids prescribed 5 doses. All patients received Dexamethasone 0.5 mg/kg up to 4 mg every 48 hours for 3 doses starting on post-operative day 1. The core metrics included initial opioid doses prescribed and oxycodone refills. Balancing measures were 7-day emergency department visits and 30-day readmission rates. Statistical process control methods were use with prospective data collection starting in September 2025.

Results: A total of 325 patients received the new opioid sparing protocol over a 4-month interval in the first Plan-Do-Study-Act (PDSA) cycle. An 18% reduction was achieved in average doses of post-operative opioids. Special cause variation (reduction) was observed for opioid refills. No special cause variation was noted in the 7-day emergency room visit and 30-day readmission rates.

Conclusions: Implementation of a standard post-tonsillectomy pain management pathway employing steroids can safely decrease post-operative opioid prescribing without adversely impacting postoperative pain. Additional PDSA cycles are required to further reduce postoperative opioid prescribing.