Inpatient opioid use after vaginal delivery

Area of Science:

• Obstetrics and Gynecology
• Pain Management
• Public Health

Background:

• Opioid exposure during hospitalization is common, potentially initiating use.
• Little is known about inpatient opioid use following vaginal delivery.
• This study addresses the gap in understanding postpartum opioid prescribing patterns.

Purpose of the Study:

• To describe opioid use in the final 24 hours of postpartum hospitalization for vaginal delivery patients.
• To identify patient and provider factors associated with this opioid use.

Main Methods:

• Retrospective case-control study of 9038 women undergoing vaginal delivery.
• Analysis of inpatient, pharmacy, and administrative records.
• Multivariable logistic regression to identify factors associated with opioid use.

Main Results:

• 24.8% of women used opioids in the last 24 hours of hospitalization.
• Factors associated with increased opioid use include higher BMI, smoking history, substance abuse, regional analgesia, birth complications, and lacerations.
• Increased acetaminophen use and orders by advanced practitioners were associated with decreased opioid use.

Conclusions:

• Nearly one-quarter of women receive inpatient opioids post-vaginal delivery.
• Patient factors partially explain opioid use variation.
• Acetaminophen use and advanced practitioner orders independently reduce inpatient opioid use.