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. 2025 May;20(5):446-453.
doi: 10.1002/jhm.13539. Epub 2024 Oct 24.

Variability in treatment of postoperative pain in children with severe neurologic impairment

Jordan Keys  1   2 , Jessica L Markham  1   2   3 , Matthew Hall  1   2   4 , Emily J Goodwin  1   2   3 , Jennifer Linebarger  1   2   3 , Jessica L Bettenhausen  1   2   3
Affiliations

Variability in treatment of postoperative pain in children with severe neurologic impairment

Jordan Keys et al. J Hosp Med. 2025 May.

Abstract

Background and objective: Treatment of postoperative pain for children with severe neurologic impairment (SNI) is challenging. We describe the type, number of classes, and duration of postoperative pain medications for procedures common among children with SNI, as well as the variability across children's hospitals in pain management with an emphasis on opioid prescribing.

Methods: This retrospective cohort study included children with SNI ages 0-21 years old who underwent common procedures between January 1, 2019 and December 31, 2019 within 49 children's hospitals in the Pediatric Health Information System. We defined SNI using previously described high-intensity neurologic impairment diagnosis codes and identified six common procedures which included fracture treatment, tracheostomy, spinal fusion, ventriculoperitoneal shunt placement (VP shunt), colostomy, or heart valve repair. Medication classes included benzodiazepines, opioids, and other nonopioid pain medications. Acetaminophen and nonsteroidal anti-inflammatory drugs were excluded from analysis. All findings were summarized using bivariate statistics.

Results: A total of 7184 children with SNI underwent a procedure of interest. The median number of classes of pain medications administered varied by procedure (e.g., VP shunt: 0 (interquartile range [IQR] 0-1); tracheostomy: 3 (IQR 2-4)). Across all procedures, opioids and benzodiazepines were the most commonly prescribed pain medications (48.8% and 38.7%, respectively). We observed significant variability in the percentage of postoperative days with opioids across hospitals by procedure (all p < .001).

Conclusion: There is substantial variability in the postoperative delivery of pain medications for children with SNI. A standardized approach may decrease the variability in postoperative pain control and enhance care for children with SNI.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Consort diagram of study sample.
FIGURE 2
FIGURE 2
Risk-adjusted overall* and unadjusted procedure-specific, interhospital variability of the percentage of postoperative days with opioid administration. * Risk adjusted for procedure type, age, number of complex chronic conditions, and severity using the Hospitalization Resource Intensity Scores for Kids (H-RISK).
See this image and copyright information in PMC

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