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Study Identifies Risk Factors for Pediatric Opioid Dependence After Surgery

Researchers at Hospital for Special Surgery (HSS) have identified risk factors for persistent opioid use after surgery in pediatric patients.1 Study findings were presented at the 2021 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.

Previous research indicates that prescription patterns for opioids after surgery in children and adolescents may be associated with long-term use and abuse.2

“Pediatric patients have developing brains that are uniquely vulnerable to addiction, and we need to learn to treat their pain safely without putting them at additional risk for opioid misuse,” said principal investigator Kathryn (Kate) DelPizzo, MD, an anesthesiologist at HSS.

It is therefore critical for clinicians to understand risk factors for opioid dependence in this vulnerable population, and to develop strategies to prevent long-term opioid use.

Dr. DelPizzo and colleagues examined insurance claims from Truven Health Marketscan data from patients under the age of 21 who underwent inpatient or outpatient surgery from 2013 to 2017. The primary outcome examined was persistent opioid use after surgery, defined as one or more additional filled opioid prescriptions between 90 and 180 days post-surgery.

Out of more than 3.7 million patients, about 9% (N=345,523) filled at least one opioid prescription within six months after surgery, and 0.3% (N=11,334) developed ongoing opioid use.

Several risk factors were identified for persistent opioid use: older age, female sex, earlier year of undergoing surgery (e.g., 2013 versus 2014 through 2017), higher burden of comorbidities, previous use of antidepressants, residence outside of the Northeastern United States, having undergone an inpatient or a musculoskeletal procedure (versus general surgery or other specialties), and previous opioid use.

“This data gives an indication that providers may be able to use a patient's baseline characteristics to predict which children and adolescents are most at risk for trouble with opioids during the postsurgical period,” Dr. DelPizzo noted.

HSS is committed to patient safety and being a leader in effective pain management. Its Controlled Substances Task Force continues to make strides in patient education and safe prescribing.

In addition to this study, HSS is ramping up further research on opioids with the help of a $3 million grant from the Starr Foundation. “Future research should explore what practical methods can be put into place to identify these at-risk pediatric patients and how to streamline protocols to help prevent long-term opioid dependence in these patients,” Dr. DelPizzo concluded.


1. Kathryn DelPizzo MD, Haoyan Zhong MPA, Lauren A. Wilson MPH, Hannah N. Ladenhauf MD, Jiabin Liu MD PhD, Jashvant Poeran MD PhD, Stavros G. Memtsoudis MD PhD MBA FCCP. “Factors Associated With Long-term Opioid Use in Pediatric Surgical Patients.” Presented at: 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), May 13-15, 2021; Orlando, FL.

2. Harbaugh CM, Lee JS, Hu HM, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics 2018; 141:e185838.

About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.