Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at…

Cohort studyAnnals of surgery open : perspectives of surgical history, education, and clinical approaches· Jun 2026

Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at Discharge.

Mallory N Perez, Lynn Huang, Willemijn L A Schäfer … Mehul V Raval

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Pediatric AnesthesiaCohort study

About a third of children received an opioid prescription at discharge after surgery.

Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at Discharge.

Mallory N Perez … Mehul V Raval

Annals of surgery open · Jun 2026

Background

Efforts to optimize opioid use in children after surgery are currently limited by insufficient information about prescribing practice variation.

Purpose

To characterize factors contributing to opioid prescribing practice variation at discharge for children after surgery and evaluate the association between discharge opioid prescribing and 30-day follow-up/complications.

Methods

Prospective cohort study of 1670 children (5-17 years) from 4 Illinois hospitals participating in the National Surgical Quality Improvement Program-Pediatric, using electronic health record data abstracted from January 2021 to April 2023.

n = 1670 children

Results

roughly a third of children left the hospital with an opioid prescription

OR 10.14 (95% CI 5.12 to 20.02)

CI excludes the null - significant

More results

Hospital site, older age (Odds ratio [OR], 2.78 [95% confidence interval (CI), 2.03-3.82]; β = 47.12, P < 0.001), preoperative non-opioid analgesia use (OR, 2.42 [95% CI, 1.63-3.62]; β = 26.84, P < 0.001), and regional anesthesia use (OR, 10.14 [95% CI, 5.12-20.02]; β = 25.77, P = 0.03 ) were associated with opioid exposure and dose intensity.

More results

Surgical specialties with increased opioid exposure did not correspond with those with higher dose intensity.

Lack of opioid exposure at discharge was not associated with pain control issues requiring follow-up care.

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Conclusion · 1 of 2

Significant variation by hospital and surgical specialty exists in opioid exposure and dose intensity for children after surgery.

Conclusion · 2 of 2

Both opioid exposure and dose intensity offer valuable, complementary insights, and therefore, should be monitored to fully optimize opioid stewardship in children after surgery.

Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at Discharge.

Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at Discharge.

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