Postoperative Opioid Prescribing Following Cleft Lip Repair in 1497 Patients

Abstract

Objective

We sought to characterize the frequency of postoperative opioid prescriptions in patients undergoing cleft lip repair (CLR).

Design

The NSQIP-P 2023 database was queried to identify patients undergoing CLR using CPT codes. Univariable analysis was conducted to identify factors associated with postoperative opioid prescription.

Setting

A multicenter sample from 157 participating sites.

Patients/participants

A total of 1497 cases (1215 unilateral CLR and 282 bilateral CLR) were identified.

Main outcomes/measures

The postoperative outcomes of interest were whether an opioid was prescribed to a patient at discharge and what factors were independently associated with opioid prescribing at discharge.

Results

A total of 44.6% of patients with a mean age of 5.1 ± 1.9 months were prescribed opioids at discharge, most commonly oxycodone (76.3%). Univariable analysis identified an increase in weight (kg) (OR: 1.09, 95% CI: 1.02-1.17, P = .03), American Society of Anesthesiologists (ASA) classification (ordinal) (OR: 1.25, 95% CI: 1.06-1.47, P = .01), anesthesia time (10 min) (OR: 1.02, 95% CI: 1.01-1.04, P = .03), and age (months) (OR: 1.06, 95% CI: 1.00-1.12, P = .04) as being associated with opioid prescription at discharge. Bilateral versus unilateral CLR (P = .49) and outpatient versus inpatient operation (P = .38) were not associated with opioid prescribing.

Conclusion

Opioid stewardship is important in pediatric care, with our results showing age, weight, anesthesia time, and ASA classifications are predictors of opioid prescription. Further research examining contributors to patient pain following CLR is necessary to optimize opioid prescribing without negatively impacting the patient.