CHICAGO — Whether children receive an opioid prescription after surgery varies substantially by procedure type and hospital, according to a new national analysis published in the Journal of the American College of Surgeons (JACS). The study also found that overall, nearly one-third of children are prescribed opioids after surgery.
Researchers said the findings underscore the importance of safe prescribing practices and may help inform future efforts to standardize opioid prescribing after pediatric surgery.
“Although opioids can be an important component of pain management after surgery, children are uniquely vulnerable to opioid-related harms, and research shows that surgery is often their first exposure to opioids,” said first author Anoosha Moturu, MD, MS, a fourth-year general surgery resident at Stanford Medicine and former clinical scholar at the American College of Surgeons (ACS). “Understanding current prescribing patterns is an important step toward ensuring each prescription is intentional, appropriate, and as safe as possible.”
Rates of opioid overdose have increased sharply since 2000, including among kids and teenagers, and remain a public health concern. Yet few pediatric surgery guidelines exist to help clinicians determine when opioids are needed after surgery and how much medication should be prescribed.
Researchers analyzed opioid prescribing after pediatric surgery using data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program–Pediatric (NSQIP-Pediatric) and the Pediatric Health Information System. The study included nearly 143,000 operations performed at 157 U.S. hospitals in 2023.
Study Results
Among 142,748 pediatric surgery patients:
- 31% received an opioid prescription at discharge.
- Prescribing rates varied substantially by procedure type. Children were most likely to be prescribed opioids after chest wall surgery (82%), lower extremity procedures (78%), and spine surgery (77%). Appendectomy (5.4%) and airway procedures (4.3%) had some of the lowest opioid prescribing rates.
- Fracture repairs, spine surgeries, lower-extremity procedures, and reconstructive operations accounted for nearly half of all opioid prescriptions in the study after accounting for procedural volume.
- The researchers also observed substantial variation in prescribing practices across hospitals for several types of surgical procedures, particularly for otology, craniofacial, and cleft lip-palate procedures.
"Children are receiving very different pain-management approaches depending on where they are treated and the type of surgery they undergo,” Dr. Moturu said. “While variation does not necessarily mean one approach is better than another, it raises important questions about how to promote more consistent, evidence-based postoperative pain management.”
The findings may help identify procedures where opioid prescribing can be reduced or avoided, particularly those with consistently low prescribing rates, the authors said.
Procedures with high or highly variable prescribing rates may represent opportunities to expand alternative pain-management strategies and reduce variation in care across hospitals.
“This study highlights the importance of analyzing large-scale opioid prescribing patterns to support safe, effective postoperative pain management in children and help hospital systems standardize care,” said senior author Mehul V. Raval, MD, MS, MBA, FACS, division head of pediatric surgery at the Ann & Robert H. Lurie Children’s Hospital of Chicago. “Benchmarking these data helps us identify opportunities to improve pain management and eliminate opioids where appropriate.”
In 2025, the ACS released an updated Pediatric Safe and Effective Pain Control After Surgery Guide, which provides hospitals and patients with recommendations and resources for safe postoperative pain control. The ACS Children’s Surgery Verification Program also includes a standard specifically focused on facilitating safe opioid prescribing patterns among verified hospitals.
The authors noted several limitations. The study did not account for inpatient pain-management practices before discharge, the amount of opioid medication prescribed, whether prescriptions were filled, how much medication patients ultimately used, or what non-opioid pain-management strategies were employed among hospitals and patients.
Future research will focus on identifying optimal opioid prescribing practices by procedure type to help inform evidence-based guidelines.
Study co-authors are Mallory Perez, MD; Willemijn Schäfer, PhD; Yao Tian, MPH; Leandra Knapp, MS; Catherine Grant, BSN, RN; Clifford Y. Ko, MD, FACS; and Jacqueline M. Saito, MD, MSCI, MBA.
The authors do not report any disclosures.
The study is published as an article in press on the JACS website.
Citation: Moturu A, Perez M, Schäfer W, et al. Use of Two National Registries to Identify Opioid Stewardship Opportunities in Children’s Surgery. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001977
