P1.038: Differences in Postoperative Opioid Prescribing for Children with Developmental Delay: A National Surgical Quality Improvement Project-Pediatrics Study

Background: Children with developmental delay may have limited or different means of expressing pain after surgery due to communication deficits or differences in sensory processing. This study evaluated opioid prescribing at hospital discharge among children with and without developmental delay undergoing surgery. We hypothesized that children with developmental delay would be less likely to receive a postoperative opioid prescription at discharge.

Methods: This was a retrospective cohort study using the 2023 National Surgical Quality Improvement Project-Pediatrics (NSQIP-P) for children ≤18y. Opioid prescribing at time of hospital discharge was evaluated by surgical specialty. Multivariable logistic regression identified demographic and clinical factors associated with receipt of an opioid prescription.

Results: A cohort of 151,244 children was identified with a median age of 8.2 years and majority were male (55.8%), White (59.7%), and non-Hispanic (65.2%). Developmental delay occurred in 24,636 children (16.3%) and 43,870 (29.0%) received an opioid prescription at discharge. On bivariate analysis, the proportion of children receiving an opioid prescription did not significantly differ between children with and without developmental delay (28.9% vs 29.5%). When controlling for demographics and clinical severity, children with developmental delay were significantly less likely to receive a postoperative opioid prescription (OR: 0.80, 95% CI: 0.77-0.84, p< 0.001; Table). Younger children were significantly less likely to receive an opioid prescription at discharge compared to children aged 12-18y (p < 0.001). Compared to White children, children in all other racial groups were less likely to receive an opioid prescription at discharge, including Black, Asian, Other, and Unknown (p < 0.001). Hispanic children were also less likely to receive an opioid prescription at discharge compared to non-Hispanic children (OR: 0.71, 95% CI: 0.68-0.74, p< 0.001). Children undergoing elective procedures were more likely to receive an opioid prescription at discharge compared to children undergoing urgent procedures (OR: 2.51, 95% CI: 2.40-2.63, p< 0.001). Compared to general surgery, children undergoing orthopedic procedures had the highest likelihood of receiving an opioid prescription at discharge (OR 23.1, 95% CI: 22.17-24.05, p< 0.001), followed by plastic surgery (OR 10.23, 95% CI: 9.71-10.77, p< 0.001), and gynecology (OR 9.68, 95% CI: 8.53-10.99, p< 0.001).

Conclusion: Children with developmental delay were significantly less likely to receive an opioid prescription at discharge. However, it is unclear whether this finding reflects current opioid stewardship efforts, prescriber bias, or potentially insufficient analgesia regimens. Further research is needed to better understand the complex postoperative pain management needs for children with developmental delay to ensure equitable, effective pain control strategies.