# Opioid Prescribing Patterns After Pediatric Adenotonsillectomy: A Bayesian Analysis of a Cross-Sectional Survey of Otolaryngologists in Canada

## TL;DR

This study examines how Canadian otolaryngologists manage pain after pediatric adenotonsillectomy, focusing on opioid use and surgeon factors influencing prescribing patterns.

## Contribution

The study uses Bayesian analysis to identify surgeon-level factors associated with opioid-sparing preferences in postoperative pain management.

## Key findings

- 73% of surveyed otolaryngologists prefer opioid-sparing analgesia after pediatric adenotonsillectomy.
- Pediatric otolaryngologists have strong evidence of opioid avoidance, with a 95% posterior probability.
- Morphine is the most commonly prescribed opioid, while codeine is least preferred.

## Abstract

Adenotonsillectomy is one of the most common pediatric surgeries, and postoperative pain management remains variable. Despite recommendations favoring non-opioid regimens, opioids continue to be prescribed, highlighting the need to better characterize current prescribing practices.

To evaluate self-reported opioid prescribing practices among Canadian otolaryngologists following pediatric adenotonsillectomy and to identify surgeon-level factors associated with opioid-sparing preferences.

National cross-sectional survey.

Members of the Canadian Society of Otolaryngology—Head & Neck Surgery.

Practicing Canadian otolaryngologists involved in the perioperative care of pediatric patients undergoing adenotonsillectomy.

Surgeon characteristics, including subspecialty training, practice setting, and surgical volume.

The primary outcome was self-reported use of opioid-sparing postoperative analgesia following pediatric adenotonsillectomy. Secondary outcomes included opioid type prescribed and reported minimum age thresholds for opioid use.

Of 517 eligible otolaryngologists, 100 responded (19.3%). Overall, 73% reported preferential use of opioid-sparing analgesia. Pediatric otolaryngologists showed strong evidence of opioid-sparing practice, with a 95% posterior probability of opioid avoidance, followed by academic (87%) and high-volume surgeons (91%). Morphine was the most-commonly-prescribed opioid (82%), whereas codeine was least preferred. Reported minimum age thresholds for opioid prescribing showed a bimodal distribution.

Most Canadian otolaryngologists surveyed reported a theoretical preference for opioid-sparing analgesia following pediatric adenotonsillectomy.

Observed practice variation, including bimodal age thresholds, highlights opportunities for opioid stewardship initiatives and quality improvement efforts. Future studies evaluating real-world prescribing behavior are needed to inform standardized postoperative pain management strategies.

Graphical Abstract