Use of 2 National Registries to Identify Opioid Stewardship Opportunities in Children’s Surgery

BACKGROUND: Pediatric postoperative opioid prescribing remains a modifiable source of harm, but procedure-specific national prescribing patterns, interhospital variability, and high-yield stewardship targets are not well defined. STUDY DESIGN: This retrospective cohort study used January to December 2023 data from NSQIP-Pediatric and the Pediatric Health Information System (PHIS) for nonneonate children aged 0 to 17 years undergoing surgery. Procedure groups were defined by CPT code. Outcomes were opioid prescription proportion (OPP), prescribing practice variability (interquartile range of hospital-level OPP), and contribution to total opioid prescriptions (CTOPs). PHIS volumes from 45 hospitals also participating in NSQIP-Pediatric were used to estimate procedure-group case volumes and CTOP. RESULTS: Among 142,748 NSQIP-Pediatric patients from 157 hospitals, 31% (44,110 of 142,748) had an opioid prescription at discharge. After PHIS case volume adjustment, this corresponded to 27% (38,102 of 142,748) of patients. The top 20 procedure groups accounted for 95% (36,241 of 38,102) of estimated opioid prescriptions at discharge. Highest OPPs were observed for chest wall procedures at 82% (1,839 of 2,242), lower extremity procedures at 78% (5,949 of 7,658), and spine procedures at 77% (7,724 of 10,047). Highest prescribing practice variability was observed for craniofacial procedures (interquartile range [IQR] 0.7), cleft lip-palate procedures (IQR 0.6), and fracture repair (IQR 0.6). Highest CTOPs were fracture repair at 16% (5,904 of 38,102), spine procedures at 13% (5,032 of 38,102), and lower extremity procedures at 13% (4,913 of 38,102). CONCLUSIONS: Pediatric postoperative opioid prescribing is concentrated within a limited number of procedure groups, with substantial variation across hospitals for selected procedures. These data identify procedure-specific opportunities for opioid stewardship initiatives in children's surgery.