Opioid prescribing practices at discharge across common pediatric surgery procedures

In 2020, the American Pediatric Surgical Association (APSA) released evidence-based recommendations for opioid prescribing after surgery, grouping procedures into opioid-free recovery (OFR) and opioid-free recovery possible (OFRP). This study investigated rates and associated factors of opioids prescribing at discharge after common general surgery procedures based on APSA recommendations.

The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P; 2023) was queried for patients <18 years undergoing elective general surgery procedures. Within NSQIP-P, OFR procedures were inguinal hernia repair and pyloromyotomy and OFRP procedures were appendectomy, cholecystectomy, and Nuss procedure. Descriptive statistics on demographics and 30-day outcomes were compared. A logistic regression model was fit for predicting opioid prescription at discharge after OFR cohort and after appendectomy, cholecystectomy, and Nuss procedure respectively.

Among 29,565 patients in the analysis, 1411 (4.8%) were classified as OFR and 28,154 (95.2%) were classified as OFRP. Within OFR procedures, 0.8% of cases were given opioid prescriptions. For OFPR procedures, 11.5% of patients were given at least one opioid prescription at discharge with 5.4% for appendectomy, 20.5% for cholecystectomy, and 85.8% for Nuss procedure. Factors associated with odds of an opioid prescription included race, ethnicity, co-morbidities, and operation length.

For procedures where OFR is recommended, surgeons are doing well at minimally prescribing opioids at discharge. For procedures considered OFRP, approximately 10% of patients are receiving opioid prescriptions at discharge with variability by procedure and patient factors including race and ethnicity. Further investigation into these and hospital level factors is needed.