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Inpatient opioid utilization in primary cleft palate repair at a tertiary pediatric center: a 10-year experience
Catherine C Kennedy, BHSc; Priya Bhardwaj MD, MS; Nicholas Roney, MD; Brenna Rachwal, MPH; Ayesha Qureshi, MD; Ibrahim Khansa MD; Gregory D Pearson, MD; Richard E Kirschner, MD; Jenny C Barker MD, PhD
OSUMC
2025-01-13
Presenter: Priya Bhardwaj, MS, MD
Affidavit:
The work presented is original by resident and team.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
We aim to determine the opioid consumption and prescribing patterns for primary cleft palate (CP) repair at our institution.
Methods:
Patients undergoing primary CP repair between 2014-2024 were retrospectively reviewed. Clinical characteristics were reported with frequencies or median (IQR), and categorical variables compared with Pearson's Chi-Square. Inpatient oral morphine equivalents (OME) were defined as the sum of opioid medications received in the post-anesthesia care unit plus floor.
Results:
487 patients underwent primary CP repair with a median operative time of 106.0min (85.0-126.0). The majority were males (52.0%) and 27.9% were syndromic. The percentage of patients classified as submucous (SM), Veau I (vI), Veau II (vII), Veau III (vIII), and Veau IV (vIV) palates were 4.9%, 18.9%, 39.0%, 25.1%, and 12.1%, respectively. Complication rate was <1%. For those prescribed opioids, median inpatient consumption was 3.70 OMEs (1.38-9.80) and was greatest in vI (6.81, 1.40-14.9) followed by vIV (6.00, 2.04-12.00), vII (3.30, 1.38-8.40), SM (2.66, 0.42-7.76), vIII (2.40, 1.10-6.99). There were significant differences in the proportion of inpatient opioid use across groups (SM 66.7%; vI 82.6%; vII 91.1%; vIII 95.9%; vIV 93.2%, p<0.0001). The lowest and highest proportion of opioid use was within the SM and vIII groups, respectively. 91.4% of patients were discharged with an opioid prescription. Of those, average OME prescribed was 15.0 (9.0-25.0).
Conclusion:
Our findings suggest a higher level of perioperative pain management may be necessary for vIII CP patients. Reduction in opioid usage, especially in other cleft classifications, may contribute to judicious opioid stewardship.
