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

ImportanceAdenotonsillectomy 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.ObjectiveTo evaluate self-reported opioid prescribing practices among Canadian otolaryngologists following pediatric adenotonsillectomy and to identify surgeon-level factors associated with opioid-sparing preferences.DesignNational cross-sectional survey.SettingMembers of the Canadian Society of Otolaryngology-Head & Neck Surgery.ParticipantsPracticing Canadian otolaryngologists involved in the perioperative care of pediatric patients undergoing adenotonsillectomy.Intervention or ExposuresSurgeon characteristics, including subspecialty training, practice setting, and surgical volume.Main Outcome MeasuresThe 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.ResultsOf 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.ConclusionsMost Canadian otolaryngologists surveyed reported a theoretical preference for opioid-sparing analgesia following pediatric adenotonsillectomy.RelevanceObserved 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.