{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:30:50Z","timestamp":1791307850505,"version":"4.3.1"},"reference-count":47,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>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\u2010Do\u2010Study\u2010Act cycles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From 1\/2015 through 12\/2023, our standardized tonsillectomy protocol underwent nine procedure\u2010specific perioperative Plan\u2010Do\u2010Study\u2010Act cycles, three procedure\u2010specific postoperative prescription Plan\u2010Do\u2010Study\u2010Act cycles, and four general ambulatory surgical center enhanced recovery Plan\u2010Do\u2010Study\u2010Act 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 (&gt;120\u2009min), and 30\u2010day reoperation rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2009min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30\u2010day reoperation rates were unchanged.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14979","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T11:35:51Z","timestamp":1725017751000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real\u2010world data"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4363-9157","authenticated-orcid":false,"given":"Jennifer L.","family":"Chiem","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Seattle Children's Hospital  Seattle Washington USA"},{"name":"Department of Anesthesiology and Pain Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6334-0916","authenticated-orcid":false,"given":"Amber M.","family":"Franz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Seattle Children's Hospital  Seattle Washington USA"},{"name":"Department of Anesthesiology and Pain Medicine University of Washington  Seattle Washington 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