Plastic Surgery Research Council

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Persistent Opioid Use Among Children, Adolescents, and Young Adults After Common Cleft Operations
Katelyn G. Bennett, MD, Calista M. Harbaugh, MD, Hsou Mei Hu, PhD, Christian J. Vercler, MD, Steven R. Buchman, MD, Jennifer F. Wajee, MD, MS.
University of Michigan, Ann Arbor, MI, USA.

PURPOSE: Surgical care represents an important source of opioid prescribing and chronic use, but rates of prolonged opioid use following pediatric procedures remain unclear. We describe the rates and risk factors for new persistent opioid use in patients after common cleft operations.
METHODS: We examined claims from the Truven Marketscan databases from January 1, 2010 to December 31, 2014. We included opioid-naive patients ages 8 to 25, who underwent one of 12 cleft-related procedures. We included a random sample of similarly aged patients without procedural codes across a similar time period as a control. Included cleft patients had no procedural six months following surgery. All cleft patients filled an opioid prescription during the perioperative period, defined as 30 days before and 14 days after surgery. The primary outcome was new persistent opioid use, defined as prescription fills between 90 and 180 days after the procedure.
RESULTS: This cohort included 2,039 cleft patients and 2,100 control patients. The incidence of new persistent opioid use following surgery was 4.4% and 0.1% in the control group. Two soft tissue operations were associated with persistent use: revision palatoplasty (aOR, 4.23: 95% CI, 1.59 - 1127, p=0.004) and major revision of nasolabial fistula (aOR, 4.88: 95% CI, 1.48 - 16.01, p=0.009). Placement of distractors was also associated with higher odds of persistent opioid use (aOR, 4.10: 95% CI 1.67 - 10.05, p=0.002). Increasing age (ages 21-25: aOR, 4.33: 95% CI, 1.87-10.0, p=0.001) and depression (aOR, 2.61: CI 1.01-6.72, p=0.047) were significant risk factors for opioid use more than three months after surgery.
CONCLUSION: New persistent opioid use occurs after both soft tissue and bony cleft-related procedures and could lead to chronic use in children, adolescents, and young adults.


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