O2110: Hospital Unit Variation in Pediatric and Neonatal Postoperative Opioid Administration

Purpose/Objectives: Though literature on long-term effects of opioid use in neonates is lacking, there is consensus that minimizing exposure in all children is ideal. However, the burden of opioid use for common surgical procedures in neonates remains undefined. This study compared patterns of opioid administration for a common operation between children recovering on a pediatric ward versus the neonatal intensive care unit (NICU).

Design/Methods: We performed a retrospective review of all pediatric and neonatal patients at a single institution undergoing isolated laparoscopic gastrostomy tube placement (LGT) from 2021 to 2023. Patients undergoing multiple procedures and those in the pediatric ICU were excluded. Opioid exposure was tracked in morphine milligram equivalents per kilogram (MME/kg), intraoperatively and for 48 hours postoperatively.

Results: A total of 158 pediatric patients (aged 0-17 years, mean=3.5 years) and 51 NICU patients (aged 3 weeks to 7 months, mean=2.8 months) were included. While intraoperative MME/kg did not differ significantly (0.53 vs. 0.51 MME/kg, p=0.8004), postoperative use was significantly higher in the NICU (0.33 vs. 0.06 MME/kg, p< 0.0001), as was number of postoperative administrations (2.29 vs. 0.51, p< 0.0001) and opioid exposure time (11.7 vs. 4.7 hours, p=0.0001). The same trend was observed on a subset analysis of a pediatric population < 12 months in comparison to the NICU population; postoperative use (0.33 vs. 0.08 MME/kg, p< 0.0001), number of postoperative administrations (2.29 vs. 0.66, p< 0.0001) and time to last opioid dose (11.65 vs. 5.74 hours, p=0.0054) were all significantly higher in the NICU than in the pediatric unit.

Conclusion/Discussion: Among patients undergoing the same procedure, NICU patients had significantly increased opioid use. Further examination is needed to identify root causes, validate this data across other procedure types and institutions, and create processes to limit opioid administration and variation across hospital units.