National prevalence of postoperative opioid prescription following cleft palate repair.

Abstract

The prevalence of postoperative opioid prescribing following palatoplasty is largely unknown. We queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2023 database to evaluate opioid prescribing at discharge and perioperative factors associated with opioid use in children aged 0-36 months undergoing palatoplasty. A total of 2026 patients (mean age 13.5 ± 4.6 months) were included. Approximately half of the patients (52.6%) received an opioid prescription at discharge, most commonly oxycodone (73.7%). Multivariable analysis demonstrated that longer anesthesia duration (OR: 1.03 per 10 min, 95% CI: 1.01-1.04, P < 0.001) and higher ASA classification (OR: 1.26, 95% CI: 1.09-1.46, P = 0.002) were independently associated with increased odds of opioid prescription at discharge, whereas Black or African American race (OR: 0.42, 95% CI: 0.30-0.60, P < 0.001) and longer time to discharge (OR: 0.93, 95% CI: 0.86-0.996, P = 0.04) were associated with decreased odds. Opioid prescribing rates following palatoplasty are high; however, variation exists across demographic and perioperative factors. Black or African American patients had lower odds of receiving a prescription, consistent with previously documented disparities in pediatric pain management. Indicators of procedural complexity, including anesthesia duration and ASA class, were associated with higher odds of prescribing. These findings highlight opportunities to refine postoperative analgesia following cleft palate repair and underscore the need for standardized, opioid-sparing strategies to optimize pain control and reduce practice variability and overprescription.