Opioid prescriptions practices following the minimally invasive repair of pectus excavatum: A Western Pediatric Surgery Research Consortium study.

PURPOSE: Minimally invasive repair of pectus excavatum (MIRPE) is among the most painful elective procedures in pediatric patients and is frequently managed with both inpatient and outpatient opioids. However, opioid prescribing practices vary, and evidence-based discharge guidelines are lacking. This study aimed to evaluate outpatient opioid prescribing patterns following MIRPE across multiple institutions.

METHODS

A multicenter retrospective review was performed of patients (<21 years) who underwent MIRPE from 2022 to 2023 across 10 hospitals in the Western Pediatric Surgery Research Consortium. Demographic, operative, inpatient, and outpatient opioid data were collected. All opioid doses were converted to oral morphine equivalents (OME) using standardized conversion factors. Associations between inpatient opioid use and discharge prescriptions were assessed with linear regression.

RESULTS

Among 532 patients (85.9 % male; median age 15.5 years [IQR 14.5-17.1]; median Haller index 4.5 [3.8-5.7]), 91 % received intercostal nerve cryoablation. Median hospital length of stay was 1 day [1-2]. Patients were discharged with a median of 10 opioid doses [8-16.5], equivalent to 75 OME [45-120] or 1.32 OME/kg [0.85-2.12]. Discharge prescriptions varied substantially by institution, ranging from 0 [0-10] to 20 [10-20] doses. Discharge OME correlated with inpatient opioid use (β = 0.35, 95%CI 0.26-0.44) and length of stay (β = 20.9, 95%CI 13.4-28.3).

DISCUSSION: Outpatient opioid prescriptions following MIRPE varied widely across hospitals and were positively associated with inpatient opioid use and hospital stay. These findings underscore the need for standardized discharge analgesia guidelines to reduce variability and minimize excess opioid prescribing in pediatric surgical care.