Hospital Unit Variation in Pediatric Postoperative Opioid Administration Is Associated With Increased Neonatal Opioid...

Opioid stewardship is an important tenet of modern pediatric surgical care. However, the burden of opioid use for common surgical procedures in infants remains undefined. We aimed to compare patterns of opioid administration for a common operation between children recovering on different hospital units.

We performed a retrospective review of pediatric and neonatal patients at a single children's hospital undergoing isolated laparoscopic gastrostomy tube placement from 2021 to 2023. Opioid exposure was tracked in morphine milligram equivalents per kilogram (MME/kg), intraoperatively and 48 h postoperatively.

A total of 158 ward (aged 0-17 y, median 14 mo) and 51 neonatal intensive care unit (NICU) patients (aged 3 wk to 7 mo, median 3 mo) were included. Intraoperative MME/kg did not differ significantly between the NICU and ward (median 0.46 versus 0.47 MME/kg, P = 0.63), but the postoperative use was significantly higher in the NICU (median 0.28 versus 0.00 MME/kg, P < 0.0001), as was the number of postoperative administrations (median 2 versus 0, P < 0.0001) and opioid exposure time (median 10 versus 2 h, P < 0.0001). Similar trends were observed on subset analysis of NICU versus ward patients ≤12 mo; the median postoperative use (0.28 versus 0.00 MME/kg, P < 0.0001), median number of postoperative administrations (2 versus 0, P < 0.0001), and median time to last dose (10 versus 2 h, P = 0.0002) were all significantly higher in the NICU.

NICU patients had a significantly higher postoperative opioid use than pediatric ward patients after identical surgeries. Further work is needed to identify root causes, validate findings across other procedures and institutions, optimize opioid stewardship, and limit variation across hospital units.