Whether a child receives an opioid prescription after surgery varies widely by type of surgery and hospital, according to a new national analysis published in . Journal of the American College of Surgeons (jacks). The study also found that overall, nearly one-third of children were prescribed opioids after surgery.
Researchers said the findings highlight the importance of safe prescribing practices and may inform future efforts to standardize opioid prescribing after pediatric surgery.
Opioids can be an important component of postoperative pain management, but children are uniquely vulnerable to opioid-related harm, and studies have shown that surgery is often their first exposure to opioids. Understanding current prescribing patterns is a critical step to ensuring each prescription is intentional, appropriate, and as safe as possible. ”
Anoosha Moturu, MD, MS, first author, fourth-year general surgery resident at Stanford University, former clinical scholar at the American College of Surgeons (ACS)
Opioid overdose rates have increased sharply since 2000, including among children and teens, and remain a public health concern. However, few pediatric surgical guidelines exist to help clinicians determine when opioids are needed after surgery and how much of the drug to prescribe.
Researchers used data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program – Pediatrics (NSQIP-Pediatric) and Pediatric Medical Information System to analyze opioid prescriptions after pediatric surgery. The study included approximately 143,000 surgeries performed at 157 U.S. hospitals in 2023.
Research results
Of the 142,748 pediatric surgical patients:
- 31% received an opioid prescription upon discharge.
- Prescription rates vary widely depending on the type of procedure. Children were most likely to be prescribed opioids after chest wall surgery (82%), lower extremity surgery (78%), and spine surgery (77%). Appendectomies (5.4%) and airway procedures (4.3%) were some of the lowest opioid prescriptions.
- Fracture repair, spine surgery, lower extremity surgery, and reconstructive surgery accounted for nearly half of all opioid prescriptions in the study, considering the volume of surgery.
- The researchers also observed large differences in prescribing practices across hospitals for several types of surgical procedures, particularly otologic, craniofacial, and cleft lip and palate surgeries.
“Children receive very different pain management approaches depending on where they are treated and the type of surgery they undergo,” Dr. Motul said. “Variation does not necessarily mean that one approach is better than another, but it does raise important questions about how to promote more consistent, evidence-based postoperative pain management.”
The authors said the findings could help identify procedures that can reduce or avoid opioid prescribing, particularly those that have consistently low prescribing rates. Surgery with high prescription rates or high variability may represent an opportunity to expand alternative pain management strategies and reduce variation in care between hospitals.
“This study highlights the importance of analyzing opioid prescribing patterns at scale to support safe and effective postoperative pain management in children and to help hospital systems standardize care,” said lead author Mehul V. Raval, MD, MS, MBA, FACS, chief of pediatric surgery at the Ann & Robert H. Lurie Children’s Hospital in Chicago. “Benchmarking these data can help identify opportunities to improve pain management and eliminate opioids if necessary.”
In 2025, ACS released the updated Pediatric Safe and Effective Postoperative Pain Management Guide, which provides hospitals and patients with recommendations and resources for safe postoperative pain management. The ACS Pediatric Surgery Validation Program also includes standards specifically focused on promoting safe opioid prescribing patterns among validated hospitals.
The authors noted several limitations. The study did not take into account the inpatient pain management practices before discharge, the amount of opioid drugs prescribed, whether the prescription was filled, the amount of drugs the patient ultimately used, and what non-opioid pain management strategies were used between the hospital and the patient.
Future research will focus on identifying optimal opioid prescribing methods for each procedure type to inform evidence-based guidelines.
sauce:
American College of Surgeons
Reference magazines:
Motsuru, A. et al. (2026) Use of two national registries to identify opportunities for opioid management in pediatric surgery. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001977. https://journals.lww.com/journalacs/abstract/9900/use_of_2_national_registries_to_identify_opioid.1758.aspx
