Variability and Excess in Opioid Prescribing Patterns After Cleft and Craniosynostosis Repairs

Objective: To critically analyze pediatric opioid prescription patterns after cleft and craniosynostosis repairs. Design: Observational study 1) retrospectively reviewing pediatric opioid prescriptions from July 2018 to June 2019 and 2) prospectively surveying patients about actual opioid use from August 2019 to February 2020. Setting: Academic tertiary care pediatric hospital. Patients: 133 pediatric patients undergoing cleft lip and/or palate or craniosynostosis repairs. Prospective surveys were offered at postoperative visits; 45 of 69 eligible patients were enrolled. Intervention: None. Main Outcome Measures: Opioid doses prescribed at discharge and actual home opioid use. Results: 90 patients with cleft lip and/or palate and 43 patients with craniosynostosis were included. Median prescribed opioid doses were 10.3 for cleft lip and/or palate procedures (range 0–75), and 14.3 for craniosynostosis repairs (range 0–50). In patients with cleft lip and/or palate, there was a negative correlation between age at surgery and prescribed opioid doses (r_s = -0.228, p = 0.031). 45 patients completed surveys of home opioid use. No patients used more than 10 doses. Forty percent used no opioids at home, 33% used 1 to 2 doses, 18% used 3 to 5 doses, and 9% used 6 to 10 doses. Conclusions: Opioid prescriptions vary widely after common craniofacial procedures. Younger patients with cleft lip and/or palate may be more likely to be prescribed more doses. Actual home opioid use is less than prescribed amounts, with most patients using five or fewer doses. A prescribing guideline is proposed.