Predicting Opioid Use Following Discharge After Cesarean Delivery

Area of Science:

• Obstetrics and Gynecology
• Pain Management
• Pharmacology

Background:

• Cesarean delivery is the most common surgical procedure in the U.S.
• Postoperative opioid prescribing practices after cesarean delivery exhibit significant variability.
• Individualizing opioid prescriptions is a key goal for optimizing patient care.

Purpose of the Study:

• To investigate patient and procedural characteristics associated with high versus low opioid use after cesarean delivery.
• To identify predictors of opioid consumption postdischarge.
• To inform strategies for personalized opioid prescribing.

Main Methods:

• Prospective cohort study quantifying opioid use for 4 weeks postdischarge.
• Data collected via health records (predischarge characteristics) and weekly patient questionnaires (postdischarge opioid use).
• Opioid use measured in milligram morphine equivalents (MMEs); regression analyses used to identify predictors.

Main Results:

• 203 patients completed the study; 113 were high opioid users (>75 MMEs) and 90 were low users (≤75 MMEs).
• Low opioid users received 44% fewer opioids pre-discharge compared to high users (33.0 vs 59.3 MMEs, P < .001).
• Limited safe storage (11.4-15.8%) and disposal (31 patients) of leftover opioids were observed.

Conclusions:

• Predischarge opioid use is a valuable metric for tailoring postoperative opioid prescriptions.
• Optimizing nonopioid analgesia and reducing overall opioid use are potential benefits.
• Further research is needed to assess the impact of these measures on prescribing, pain, and functional outcomes.