P1.062: Variation in Regional Anesthesia for Children Undergoing Surgery in National Surgical Quality Improvement Program-Pediatric

Background: Regional anesthesia provides targeted analgesia and promotes enhanced recovery in pediatric surgical patients. Despite these benefits, the prevalence and variation in regional anesthesia use for pediatric surgery have not been fully explored. This study aimed to examine factors associated with variation in regional anesthesia use and evaluate its relationship with discharge opioid prescribing practices in children undergoing surgery.

Methods: This prospective cohort study (1R21HD104078-01A1) leveraged electronic health record data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric), supplemented with additional pain management-specific variables. Children (5-18 years) undergoing any procedure in NSQIP-Pediatric at four Illinois (IL) hospitals from 2021-2023 were eligible. Procedures were identified by CPT code and selected for procedure-level analysis based on overall volume and regional anesthesia use. Regional anesthesia included cryoablation, epidural/spinal, caudal, transversus abdominis plane (TAP), and other nerve blocks. Regional anesthesia use was first assessed across hospitals and surgical specialties using Fisher’s exact tests. A multivariable logistic regression was then conducted to identify factors associated with regional anesthesia use. At the procedure level, discharge opioid exposure (opioid prescription at discharge) and dose intensity (total morphine milligram equivalents [MME]) were compared between patients with and without regional anesthesia, using chi-square and Wilcoxon rank sum tests. Statistical significance was defined as p< 0.05.

Results: Of 1,666 pediatric surgical patients, 347(21%) received regional anesthesia, primarily nerve (N=116, 33%) or epidural/spinal (N=100, 29%) blocks. Regional anesthesia use varied by hospital (0.35-42%) and surgical specialty (3.7-38%) (p < 0.001) (Table 1). For the regression, open surgery (OR=4.56; 95%CI [2.9,7.3]; p< 0.001), elective cases (OR=2.52; 95%CI [1.5,4.1]; p< 0.001), and use of preoperative non-opioid analgesia (OR=18.9; 95%CI [11.3,31.6]; p< 0.001) were associated with higher odds of regional anesthesia use, while Black race was associated with lower odds (OR=0.33; 95%CI [0.18, 0.62]; p< 0.001). Among children who underwent spine surgery (N=147), regional anesthesia was associated with higher odds of discharge opioid exposure (OR=13.5; 95%CI [3.81,47.9], p< 0.001) and greater dose intensity (p < 0.001). For abdominal surgery via laparotomy (N=82), regional anesthesia was also associated with higher odds of discharge opioid exposure (OR=2.49; 95%CI [1.01,6.13], p=0.04) but not with dose intensity (p=0.32) (Table 2).

Conclusion: Regional anesthesia for pediatric surgical patients was used in less than a quarter of NSQIP-Pediatric procedures and varied widely by hospital and surgical specialty. Further, for some procedures, regional anesthesia was not associated with reduced discharge opioid exposure or dose intensity. Given that the study included only 4 IL hospitals, a larger, more diverse sample could enhance the generalizability of results and enable a more rigorous evaluation of the association between regional anesthesia and discharge opioid prescribing practices.