The Effect of Decreased Opioid Prescribing After Routine Vaginal Delivery on Post Discharge Patient Encounters [37P]

Abstract

INTRODUCTION: In line with nationwide commitment to decrease opioid prescribing, our department instituted new guidelines to no longer routinely provide opioids at discharge following vaginal delivery. The purpose of this study was to measure the effect of this change on discharge opioid prescriptions and postpartum encounters. METHODS: This was a retrospective cohort study of patients who underwent vaginal delivery during two time periods: November 2016 to January 2017 before the guideline and November 2017 to January 2018 after its implementation. IRB approval was obtained. Exclusion criteria included substance use disorder history, age under 18 and having a contraindication for nonopioid analgesic use. The number of patients who were provided discharge opioid prescriptions or had an outpatient encounter related to pain within six weeks postpartum were compared using Student t-tests. RESULTS: A total of 1,188 patients delivered during the study periods, of those 810 met inclusion criteria. 405 patients delivered prior to the guideline and 405 after its implementation. The proportion of patients prescribed opioids decreased from 79.8% (n=323) to 7.2% (n=29) after the guideline (p<0.001). The number of patients who had a post-discharge outpatient encounter (either in the Emergency Department, clinic or via phone call) related to pain did not change (4% before and 6.7% after the guideline; p = 0.085). The majority of encounters were related to dysuria and pain around repaired lacerations. CONCLUSION: Substantially limiting opioid prescribing after vaginal delivery does not appear to increase the burden of outpatient patient encounters after discharge.