Discharge Opioid Prescribing After Primary Cleft Lip and Palate Repair: A National Analysis of Prevalence, Predictors, and Safety

Opioid stewardship has changed surgical prescribing yet discharge opioid use after cleft lip and palate repair remains poorly described. No prior study has tied the prescribing habits to postoperative complications. Using the 2023 to 2024 NSQIP-Pediatric files, we identified primary cleft lip and palatoplasty cases and characterized the prevalence, predictors, and 30-day safety of discharge opioid prescribing after primary cleft repair. Predictors of discharge opioid receipt were assessed with multivariable logistic regression. For each 30-day complication, the association with prescribing was estimated 3 ways: covariate-adjusted regression, propensity-score matching, and inverse-probability weighting, with correction for multiple comparisons. Among 7758 children (3431 cleft lip; 4327 palatoplasty), 43.8% and 51.7% received a discharge opioid, respectively. Higher ASA class and longer operative time increased the odds of opioid prescribing. Black children undergoing palatoplasty had lower adjusted odds than White children (OR 0.59, P<0.001). No complication differed by opioid status after correction. Wound dehiscence and reoperation, the outcomes most tied to protecting the repair, were nearly identical between prescribed and nonprescribed children. Discharge opioid prescribing after primary cleft repair varied widely by surgeon specialty and by race but was not associated with 30-day complications, readmission, or reoperation. Because lower prescribing was not accompanied by higher rates of dehiscence, reoperation, or readmission, opioid-sparing discharge protocols are unlikely to compromise surgical outcomes and offer a route toward more consistent and equitable prescribing.