Postoperative opioids still prevalent in pediatric surgery

A recent retrospective cohort study published in the Journal of the American College of Surgeons finds that postoperative opioid prescribing for pediatric surgery patients “remains a modifiable source of harm” while noting that “procedure-specific national prescribing patterns, inter-hospital variability, and high-yield stewardship targets are not well defined.”

Using 2023 data from NSQIP-Ped and the Pediatric Health Information System, the researchers evaluated non-neonate children aged zero to 17 years undergoing surgery. Among 142,748 NSQIP-Ped cases from 157 hospitals, they found that 31% of the patients received an opioid prescription at discharge. After PHIS case-volume adjustment, this corresponded to 27% of cases.

The researchers focused on three outcomes:

• The highest Opioid Prescription Proportions were observed for chest wall procedures (82%), lower extremity procedures (78%), and spine procedures (77%).
• The highest Prescribing Practice Variability was observed for craniofacial procedures, cleft lip-palate procedures, and fracture repair (IQR 0.6).
• The highest Contribution to Total Opioid Prescriptions were observed for fracture repair at (16%), spine procedures (13%), and lower extremity procedures (13%).

The researchers concluded, “Pediatric postoperative opioid prescribing is concentrated within a limited number of procedure groups, with substantial variation across hospitals for selected procedures. These data identify procedure-specific opportunities for opioid stewardship initiatives in children’s surgery.”

Access the full study here.