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Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at Discharge

Mallory N Perez1, Lynn Huang2, Willemijn L A Schäfer2

  • 1From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.

Annals of Surgery Open : Perspectives of Surgical History, Education, and Clinical Approaches
|June 25, 2026
PubMed

Insights

Pediatric post-surgery opioid prescribing varies significantly by hospital and specialty. Discharge opioid use was not linked to follow-up pain issues, highlighting the need for careful opioid stewardship in children.

Area of Science:

  • Pediatric Surgery
  • Pain Management
  • Pharmacology

Background:

  • Optimizing opioid use in children post-surgery is hindered by a lack of data on prescribing variations.
  • This study provides a comprehensive analysis of discharge opioid prescribing practices across pediatric surgical fields and institutions.

Purpose of the Study:

  • To identify factors influencing opioid prescribing variability in pediatric surgical discharge.
  • To assess the relationship between discharge opioid prescriptions and 30-day follow-up care or complications.

Main Methods:

  • A prospective cohort study involving 1670 children (aged 5-17) across 4 Illinois hospitals.
  • Utilized electronic health record data from January 2021 to April 2023, analyzing opioid exposure and dose intensity (morphine milligram equivalents).
  • Employed multivariable logistic and linear regressions to examine associations between patient/clinical factors and opioid prescribing outcomes.

Main Results:

  • 34% of children received discharge opioid prescriptions, with a median dose intensity of 80 MMEs.
  • Factors associated with opioid exposure and dose intensity included hospital site, older age, preoperative non-opioid analgesia, and regional anesthesia.
  • No correlation was found between higher opioid exposure specialties and higher dose intensity; lack of discharge opioids did not correlate with follow-up pain issues.

Conclusions:

  • Substantial variation exists in pediatric post-surgical opioid exposure and dose intensity based on hospital and surgical specialty.
  • Monitoring both opioid exposure and dose intensity is crucial for effective opioid stewardship in pediatric surgical care.
  • Discharge opioid prescribing patterns do not appear to negatively impact 30-day pain control outcomes.
Abstract

Keywords:
opioidpain managementpediatricquality improvementsurgery

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