Variations in Postpartum Opioid Prescribing Practices among Obstetrician-Gynecologists.

Area of Science:

• Obstetrics and Gynecology
• Pain Management
• Public Health

Background:

• The US opioid crisis has impacted postpartum patients, necessitating careful management of opioid prescriptions.
• Previous studies suggested using prior day inpatient opioid use to guide discharge opioid quantities.
• The American College of Obstetrics and Gynecologists (ACOG) issued Committee Opinion 742 in July 2018, recommending shared decision-making for postpartum pain management.

Purpose of the Study:

• To investigate if the timing of opioid prescription (day of discharge vs. prior day) influences prescribing practices for cesarean deliveries.
• To assess changes in postpartum opioid prescribing for cesarean deliveries after the ACOG Committee Opinion 742 publication.

Main Methods:

• Retrospective chart review of cesarean births at a Midwest facility (July 2017 - Feb 2021).
• Opioid amounts standardized to oral morphine milligram equivalents (MME).
• Patients stratified by prescription timing (day of vs. prior to discharge) and delivery date (pre/post ACOG Opinion 742).

Main Results:

• Most cesarean patients (93.9%) received discharge opioid prescriptions.
• No significant difference in MME, doses per day, or dosage based on prescription timing.
• Deliveries after ACOG Opinion 742 publication showed significantly lower average MME (159.53 MME) compared to pre-publication (187.35 MME).

Conclusions:

• The specific post-operative day for writing opioid prescriptions did not impact prescribing trends for cesarean deliveries.
• Post-ACOG Opinion 742, discharge opioid prescriptions for cesarean patients were reduced in MME and doses per day.
• Findings align with national trends of decreased opioid prescribing.