Opioid Prescribing in Children with Neurocognitive Disability and Perforated Appendicitis: A Propensity Score Matched...

Children with neurocognitive disability (NCD) may have limited means of expressing discomfort after surgery. This study evaluated postoperative pain management among children with and without NCD undergoing surgery for perforated appendicitis.

This retrospective cohort study was conducted using the Pediatric Health Information System for children 2-18y who underwent appendectomy for perforated appendicitis between 2016-2023. NCD was identified using ICD-10 codes. Propensity score matching (PSM) was used to compare children with NCD to those without. Bivariate comparisons evaluated cumulative days of postoperative opioid and non-opioid use, and logistic regression evaluated likelihood of 30-day readmission.

Overall, 43,751 children were identified (178 with NCD, 0.41%). After PSM, the analytic sample (n=356) had no significant differences between matched demographic and clinical factors. There was no difference in median cumulative days of postoperative opioid treatment between children with NCD and those without NCD (2d, IQR: 1.0-4.0 vs 2d, IQR: 1.0-3.0, p=0.874), and no difference in median cumulative days of postoperative non-opioid analgesic treatment (3d, IQR: 2.0-6.0 vs 3d, IQR: 2.0-5.0, p=0.105). However, compared to children without NCD, those with documented NCD were associated with an increased median length of stay (LOS) (5d, IQR: 3.0-9.0 vs 4d, IQR: 3.0-6.0, p=0.004), and increased likelihood of 30-day readmission (OR 2.41; 95% CI 1.51-3.86).

Children with and without NCD had similar postoperative opioid and non-opioid prescribing but significantly different postoperative outcomes. Despite similar analgesic use, children with NCD may have atypical pain expressions that could contribute to postoperative outcomes. Thus, standardized approaches may not fully address their postoperative recovery.