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

Objective: To characterize factors contributing to opioid prescribing practice variation at discharge for children after surgery and evaluate the association between discharge opioid prescribing and 30-day follow-up/complications. Background: Efforts to optimize opioid use in children after surgery are currently limited by insufficient information about prescribing practice variation. This paper comprehensively examines discharge opioid prescribing practices across pediatric surgical specialties and hospitals. Methods: Prospective cohort study of 1670 children (5–17 years) from 4 Illinois hospitals participating in the National Surgical Quality Improvement Program-Pediatric, using electronic health record data abstracted from January 2021 to April 2023. Primary outcome measures were opioid exposure (receiving an opioid prescription at discharge) and opioid dose intensity (total morphine milligram equivalents [MMEs] prescribed) at discharge. Associations between each of the primary outcomes and patient/clinical factors were evaluated with multivariable logistic and multivariable linear regressions. Results: In total, 566 (34%) children had an opioid exposure with median dose intensity 80 MMEs/prescription (interquartile range: 50–125) at discharge. Hospital site, older age (Odds ratio [OR], 2.78 [95% confidence interval (CI), 2.03–3.82]; β = 47.12, P < 0.001), preoperative non-opioid analgesia use (OR, 2.42 [95% CI, 1.63–3.62]; β = 26.84, P < 0.001), and regional anesthesia use (OR, 10.14 [95% CI, 5.12–20.02]; β = 25.77, P = 0.03 ) were associated with opioid exposure and dose intensity. Surgical specialties with increased opioid exposure did not correspond with those with higher dose intensity. Lack of opioid exposure at discharge was not associated with pain control issues requiring follow-up care. Conclusions: Significant variation by hospital and surgical specialty exists in opioid exposure and dose intensity for children after surgery. Both opioid exposure and dose intensity offer valuable, complementary insights, and therefore, should be monitored to fully optimize opioid stewardship in children after surgery.