{"doi":"10.1007/s00246-025-04058-2","title":"Opioid and Methadone Prescribing for Infants with Surgical Management of Congenital Heart Disease","abstract":"Opioids are commonly prescribed for infants after congenital heart disease (CHD) surgery, and prolonged exposure can lead to physiologic dependence requiring methadone treatment. The Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2) categorizes operative mortality risk and may also help identify infants at greatest risk for methadone treatment. A retrospective cohort study of infants < 1 year undergoing CHD surgery between 2016-2022 at 48 U.S. children's hospitals using the Pediatric Health Information System was performed. Infants were categorized by RACHS-2 score (1 = lowest, 5 = highest risk). Multivariable hierarchical logistic regression evaluated associations between postoperative opioid days and methadone treatment, including an interaction between RACHS-2 and opioid exposure. Secondary analyses compared postoperative length of stay (LOS), ventilator days, and total parenteral nutrition (TPN) days by methadone status. Among 34,127 infants, higher RACHS-2 scores were associated with longer postoperative opioid exposure (p < 0.001). For infants who received < 17 days of opioids, increasing RACHS-2 scores predicted greater probability of methadone treatment. After 17 days, RACHS-2 score 1 infants had the highest probability of methadone treatment, though they represented a minority. Methadone was independently associated with longer LOS, ventilator days, and TPN days. Higher RACHS-2 scores were associated with increased likelihood of postoperative methadone treatment in the early postoperative period. Methadone treatment was associated with adverse short-term health outcomes. For infants with prolonged opioid exposure, those with lower RACHS-2 scores were more likely receive methadone treatment- highlighting subpopulations that may benefit from targeted opioid stewardship initiatives.","journal":"Pediatric Cardiology","year":2025,"id":580369,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9491,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":738824,"name":"Shadassa Ourshalimian","orcid":"0000-0003-2091-665X","position":1,"is_corresponding":false},{"id":1083374,"name":"Olivia A. Keane","orcid":"0000-0001-9464-1949","position":2,"is_corresponding":false},{"id":796931,"name":"Ashwini Lakshmanan","orcid":"0000-0001-8259-1905","position":3,"is_corresponding":false},{"id":762727,"name":"Cynthia Herrington","orcid":null,"position":4,"is_corresponding":false},{"id":1127201,"name":"Lara P. Nelson","orcid":"0000-0001-8640-5639","position":5,"is_corresponding":false},{"id":414306,"name":"Henry Lee","orcid":"0000-0001-8383-1720","position":6,"is_corresponding":false},{"id":238382,"name":"Susan R. Hintz","orcid":"0000-0001-7023-4433","position":7,"is_corresponding":false},{"id":110026,"name":"Nam Nguyen","orcid":"0000-0002-3932-063X","position":8,"is_corresponding":false},{"id":1491620,"name":"Malia Szyman","orcid":null,"position":9,"is_corresponding":false},{"id":738826,"name":"Lorraine I. Kelley‐Quon","orcid":"0000-0002-1735-0897","position":10,"is_corresponding":false},{"id":1278354,"name":"Rabab M. Barq","orcid":"0000-0003-0402-706X","position":0,"is_corresponding":true}],"reference_count":39,"raw_metadata":null,"created_at":"2026-07-19T02:58:38.868285Z","pmid":"41201594","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}