Opioid Prescribing in Pediatric Surgery Is Concentrated in Limited Procedure Groups

Moturu A, Perez M, Schafer W, Tian Y, et al. Use of 2 National Registries to Identify Opioid Stewardship Opportunities in Children’s Surgery. J Am Coll Surg. June 2026.

Pediatric postoperative opioid prescribing remains a modifiable source of harm, but procedure-specific national prescribing patterns, inter-hospital variability, and high-yield stewardship targets are not well defined.

This retrospective cohort study used January 2023 to December 2023 data from NSQIP Pediatric and Pediatric Health Information System (PHIS) for non-neonate children aged 0–17 years undergoing surgery. Procedure groups were defined by CPT code. Outcomes were Opioid Prescription Proportion (OPP), Prescribing Practice Variability (PPV; interquartile range of hospital-level OPP), and Contribution to Total Opioid Prescriptions (CTOP). PHIS volumes from 45 hospitals also participating in NSQIP-Ped were used to estimate procedure-group case volumes and CTOP.

Among 142,748 NSQIP-Ped cases from 157 hospitals, 31% (44,110/142,748) had an opioid prescription at discharge. After PHIS case-volume adjustment, this corresponded to 27% (38,102/142,748) of cases. The top 20 procedure groups accounted for 95% (36,241/38,102) of estimated opioid prescriptions at discharge. 

The highest OPPs were observed for chest wall procedures at 82% (1,839/2,242), lower extremity procedures at 78% (5,949/7,658), and spine procedures at 77% (7,724/10,047). Highest PPV was observed for craniofacial procedures (IQR 0.7), cleft lip-palate procedures (IQR 0.6), and fracture repair (IQR 0.6). Highest CTOPs were fracture repair at 16% (5,904/38,102), spine procedures at 13% (5,032/38,102), and lower extremity procedures at 13% (4,913/38,102).

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.