Objective: To evaluate the effect of discharge order sets on prescribing patterns of opioids after pediatric tonsillectomy. Secondary outcomes included encounters for postoperative pain, dehydration, and bleeding.Methods: Retrospective chart review of pre-and post-intervention in pediatric post-tonsillectomy patients, 0-18 years old (n = 1486). Order sets were installed with age-specific analgesic medication defaults and recommendation of concurrent alternating scheduled ibuprofen and acetaminophen. Time-balanced pre-and post-intervention cohorts were established. Opioid outcomes calculated in morphine milligram equivalents per kilogram (MME/kg) per dosage and total prescribed.Results: Discharge order set intervention resulted in 17% reduction of opioid dose prescribed (0.095 MME/kg [95% CI, 0.092-0.099] vs. 0.079 [95% CI, 0.076-0.083], P < .001). Total number of opioid doses prescribed was reduced after order set implementation (46.4 [95% CI,.1] to 20.3 [95% CI, 19.1-21.5], P < .001). Patients <7 years old prescribed opioids remained rare in pre-and post-intervention groups (1.6% and 1.8%, respectively, P = .86). Admissions and emergency department visits for postoperative dehydration and pain were significantly reduced. Post-intervention group showed an increase in readmissions for post-tonsillectomy hemorrhage (9.2% vs. 5.2%, P = .003) which was isolated to an increase in the older post-intervention group after stratification by age.Conclusion: Utilization of order sets with standardized analgesic medication regimen of acetaminophen, ibuprofen, and opioid helped effectively reduce opioid amount per dose, total opioid amount dispensed, and variability in the total opioid amount dispensed while maintaining pain control. An increase in post-tonsillectomy hemorrhage was recognized following this implementation which did not persist after the study period despite continuation of intervention.

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Purpose: Head and neck cancers (HNC) have high predilection of cervical lymph node metastases resulting in patients undergoing neck dissection (ND). Due to post-operative shoulder morbidity risks from ND, physical therapy (PT) has been used to address those complications, though studies are limited in demonstrating its efficacy. This study aims to evaluate the effects of PT on measures of shoulder pain and disability, quality of life, and shoulder mobility of patients that underwent ND as part of treatment for HNC. Methods: Literature search was performed by two authors independently. Studies assessing effects of PT for HNC patients treated with ND were evaluated. Primary outcomes and measurements were Shoulder Pain and Disability Index (SPADI), Neck Dissection Impairment Index (NDII), and active shoulder abduction (ASA) in degrees.Results: 108 patients from 3 studies. Effectiveness of PT on shoulder pain and disability, quality of life, and shoulder mobility were evaluated by SPADI, NDII, and ASA respectively. Pooled analyses of intervention (structured PT) versus control (standard, self-directed PT) mean differences (MD) for SPADI (MD=-8.13, 95% CI [-14.06, -2.12], p=0.007) and ASA (MD=24.74, 95% CI [6.71,42.76], p=0.007) favoured intervention, while NDII (MD=6.74, 95% CI [-2.55,16.03], p=0.16) favoured neither.Conclusions: Rigorous therapy appears to provide greater benefits for shoulder pain, disability, and mobility. Further studies are warranted to characterize programs offering maximal support for this cohort of patients. Implications for Cancer Survivors:Suggests that cancer survivors should be more aggressive towards physical therapy to improve shoulder function and pain after undergoing ND.

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