Opioid prescribing trends in postpartum women: a multicenter study

Abstract

BACKGROUND: The postpartum period can be a particularly vulnerable time for exposure to opioid medications, and there are currently no consensus guidelines for physicians to follow regarding opioid prescribing during this period. OBJECTIVE: The purpose of this study was to evaluate inter-and intrahospital variability in opioid prescribing patterns in postpartum women and better understand the role of clinical variables in prescribing. STUDY DESIGN: Data were extracted from electronic medical records on 4248 patients who delivered at 6 hospitals across the United States from January 2016 through March 2016. The primary outcome of the study was postpartum opioid prescription at the time of hospital discharge. Age, parity, route of delivery, and hospital were analyzed individually and with multivariate analyses to minimize confounding factors. Statistical methods included c 2 to analyze frequency of opioid prescription by hospital, parity, tobacco use, delivery method, and laceration type. An analysis of variance was used to analyze morphine equivalent dose by hospital. RESULTS: The percentage of women prescribed postpartum opioids varied significantly by hospital, ranging from 27.6% to 70.9% (P <0.001). Oxycodone-acetaminophen was the most commonly prescribed medication (50.3%) with each hospital having its preferred opioid type. Median number of tablets prescribed ranged from 20 to 40 (P < .0001). Primiparous women were more likely to receive opioids than multiparous women when broken down by a parity of 1, 2, 3, 4, and !5 (52.8%, 48.0%, 47.6%, 40.1%, and 45.8%, respectively, P ¼ .0005). Among women who had vaginal deliveries, opioid prescription rates were higher in women who experienced either a second-degree laceration (35.5%, P ¼ .0002) or a third-/fourthdegree laceration (59.3%, P < .001). CONCLUSION: Postpartum opioid prescription rates vary widely among hospitals, but providers within the same hospital tend to follow similar prescribing trends. The variation in prescribing found in our study illustrates the need for clear consensus guidelines for postpartum pain management.

Variations in Postpartum Opioid Prescribing Practices among Obstetrician-Gynecologists

“…This was consistent with other studies, where 94% to 97% were prescribed discharge opioids after caesarean deliveries. 3,4 However, the current study contributes to the literature due to its rural setting and population, whereas previous studies have been conducted in large medical centers with more patients and more diverse samples that may not reflect rural communities. The current study was unique in that it explored the discharge opioid prescribing patterns for patients with caesarean deliveries in relation to the day of hospital stay that the discharge prescription was written, as well as if the surgery occurred before or after the publication of ACOG Committee Opinion 742.…”

“…Although postpartum caesarean and vaginal delivery patients often were prescribed opioids, patients with caesarean deliveries more commonly were prescribed discharge opioid prescriptions. 3 However, there was a lack of standardization regarding the quantity of opioids prescribed for caesarean or vaginal deliveries; 3 , 4 the quantities did not always correlate with postpartum patient’s measures of pain, 4 and patients often were prescribed more opioids than what was consumed. 5 , 6 …”

“…1 Although postpartum caesarean and vaginal delivery patients often were prescribed opioids, patients with caesarean deliveries more commonly were prescribed discharge opioid prescriptions. 3 However, there was a lack of standardization regarding the quantity of opioids prescribed for caesarean or vaginal deliveries; 3,4 the quantities did not always correlate with postpartum patient's measures of pain, and patients often were prescribed more opioids than what was consumed. 5,6 Prior studies have described the quantity of discharge opioid prescriptions written on the day of discharge and evaluated if accounting for the usage of inpatient opioids on the day prior to discharge had an impact on how much was prescribed.…”

Comparison of Postoperative Opioid Use in Mothers with Neonates in the Neonatal Intensive Care Versus in the Regular Nursery or Rooming In

“…Opioids are generally the mainstay of treatment at this time [14]. Multiple studies have documented inpatient use of opioids rates up to 58% for vaginal deliveries and 100% for cesarean sections [22] with 24% of patients continuing to use opioids even in the last 24 hours of hospitalization [2].…”

“…Although other areas of opioid use have been extensively studied including those at greater risk for substance abuse [1,2,4,7,8,10,11,14,20,30] and provider prescription patterns [14][15][16]19,22], no research to date has focused on whether there is a difference in postoperative opioid use in women with neonates in the NICU versus the WBN.…”