Predictors of In-Hospital Opioid Consumption and Discharge Prescribing Following Cesarean Delivery

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Pain Management

Background:

• Cesarean delivery (CD) is a common surgical procedure.
• Opioid analgesia is frequently used for postoperative pain management.
• Understanding factors influencing opioid consumption and prescribing after CD is crucial for optimizing patient care and mitigating risks.

Purpose of the Study:

• To investigate patient and care characteristics associated with in-hospital opioid consumption.
• To examine factors related to opioid prescribing at discharge following cesarean delivery.
• To identify potential strategies for reducing opioid-related harms in the postpartum period.

Main Methods:

• Retrospective cohort study of patients undergoing cesarean delivery under neuraxial anesthesia.
• Data collected included patient demographics, care characteristics, in-hospital opioid consumption, and discharge opioid prescriptions (morphine 5 mg pills).
• Negative binomial regression was used for predictor analysis, with multiple imputations for missing data.

Main Results:

• Median in-hospital opioid consumption was low (0 morphine 5 mg pills).
• Opioid consumption was associated with prior opioid use during pregnancy, higher postoperative pain, and higher post-anesthesia care unit opioid consumption.
• Nearly 90% of patients received discharge opioid prescriptions (median 20 pills), with preprinted prescription forms influencing the quantity prescribed.

Conclusions:

• In-hospital opioid consumption following cesarean delivery is generally low and linked to specific patient and care factors.
• Discharge opioid prescribing practices, particularly the use of preprinted prescriptions, significantly influence the quantity dispensed.
• Findings support the development of targeted strategies to manage pain and reduce opioid-related harms after cesarean delivery.