Opioid Prescribing Practices at Discharge Across Common Pediatric Surgery Procedures

Introduction: In 2020, the American Pediatric Surgical Association (APSA) released evidence-based recommendations for opioid prescribing after surgery, grouping procedures into opioid-free recovery (OFR) and opioid-free recovery possible (OFRP). This study investigated rates and associated factors of opioids prescribing at discharge after common general surgery procedures based on APSA recommendations. Methods: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P; 2023) was queried for patients <18 years undergoing elective general surgery procedures. Within NSQIP-P, OFR procedures were inguinal hernia repair and pyloromyotomy and OFRP procedures were appendectomy, cholecystectomy, and Nuss procedure. Descriptive statistics on demographics and 30-day outcomes were compared. A logistic regression model was fit for predicting opioid prescription at discharge after OFR cohort and after appendectomy, cholecystectomy, and Nuss procedure respectively. Results: Among 29,565 patients in the analysis, 1411 (4.8%) were classified as OFR and 28,154 (95.2%) were classified as OFRP. Within OFR procedures, 0.8% of cases were given opioid prescriptions. For OFPR procedures, 11.5% of patients were given at least one opioid prescription at discharge with 5.4% for appendectomy, 20.5% for cholecystectomy, and 85.8% for Nuss procedure. Factors associated with odds of an opioid prescription included race, ethnicity, co-morbidities, and operation length. Conclusion: For procedures where OFR is recommended, surgeons are doing well at minimally prescribing opioids at discharge. For procedures considered OFRP, approximately 10% of patients are receiving opioid prescriptions at discharge with variability by procedure and patient factors including race and ethnicity. Further investigation into these and hospital level factors is needed.