Enhanced Recovery After Surgery Protocols Can Vastly Decrease Rates of Outpatient Opiate Prescribing in Pediatric Plastic Surgery Patients

ObjectiveThis study analyzes pediatric plastic surgery outpatient opioid prescribing rates at a single institution that implemented Enhanced Recovery After Surgery (ERAS) protocols with the national average.DesignA retrospective analysis was performed using the 2023 ACS NSQIP Pediatric Opioid Stewardship Report.Setting:The study was conducted at a single academic pediatric hospital participating in the ACS NSQIP Pediatric registry.Patients/ParticipantsPediatric patients who underwent common plastic surgery procedures between January 1 and December 31, 2023, as reported by NSQIP, were included. This comprised 146 patients from the study institution and 10 557 patients from 157 other NSQIP-participating hospitals.InterventionsERAS protocols emphasizing non-opioid multimodal analgesia were implemented in 2018. No outpatient opioids were prescribed for cleft lip repair, cranial spring placement/removal, or mandibular distraction osteogenesis. For more invasive procedures, patients received 3 doses of oral oxycodone.Main Outcome Measure(s)The primary outcome is the rate of outpatient opioid prescribing at the study institution compared to the national average, stratified by age group (adolescents, children, infants/small children, and neonates).ResultsThe study institution had a significantly lower prescribing rate (10.96%) versus the national average (51.81%) (<i>P</i> < .000001). By age group: adolescents (23.81% vs 63.20%), children (5.88% vs 52.82%), and infants/small children (6.45% vs 45.85%), all <i>P</i> < .000001. No neonates at the study site received opioids, compared to 13.83% nationally (<i>P</i> = .566).ConclusionsERAS protocol implementation is associated with a significant reduction in outpatient opioid prescribing. Broader adoption may improve opioid stewardship in pediatric plastic surgery.