Trends In Opioid Prescribing After Common Pediatric Plastic Surgery Procedures

PURPOSE: Children born with congenital conditions often require multiple reconstructive surgeries throughout childhood. Understanding postoperative pain management is important to optimize care, yet there are few standardized guidelines on perioperative opioid prescribing for these procedures. The objective of this study was to evaluate trends in opioid prescribing patterns for pediatric patients after common pediatric plastic surgery procedures. METHODS: Using Marketscan data, we identified privately insured and Medicaid pediatric patients undergoing common plastic surgery procedures between 2016 and 2021 who were opioid naïve, or without opioid fills in the 180 days prior to surgery. We examined the initial opioid prescription size (OME/day) and duration (day supply) as well as rates of high-risk prescribing over time. Multivariable regression was used to evaluate factors associated with changes in prescribing over time. RESULTS: Overall, the rate of perioperative opioid prescription fills significantly decreased from 59.3% to 42.7% (p<0.001). The average prescription duration (SD) declined from 6.5(4.6) days to 3.2(1.7) days (p<0.0001). The average initial opioid prescription size (SD) peaked at 37.8(242.4) OME/day in in 2019 and decreased to 27.9(65.5) OME/day in 2021(p=0.783). Concurrently, rates of high-risk prescribing decreased from 17.3% (95%CI:15.9%-18.8%) in 2016 to 1.8% (95%CI:1.2%-2.3%) in 2021(p<0.0001). The odds of high-risk prescribing declined significantly each year over the study period (p<0.001). CONCLUSION: Encouragingly, the rate of high-risk opioid prescribing as well as the initial opioid prescription size and duration after pediatric plastic surgery procedures have decreased over time. These trends suggest that increased awareness of opioid related harms can promote safer opioid stewardship.