Association between postcesarean delivery inpatient opioid consumption & post-discharge opioid usage: a prospective...

The United States continues to experience increasing morbidity and mortality from opioid misuse with prescription opioids. Prescription opioids account for 32% of opioid related deaths. Cesarean delivery is the most common surgery among females. This makes this patient population directly at risk for opioid misuse as 75% of opioid prescriptions are filled after a cesarean delivery. Creating a plan for optimizing postpartum opioid pain control while limiting narcotic usage is a must. Primary objective was to identify an association of inpatient opioid use and post-discharge opioid consumption after cesarean delivery (CD).

This prospective, observational study at a single academic tertiary hospital included patients undergoing CD between February to October of 2021. 142 patients met inclusion criteria with 110 (77%) patients completing the follow up phone call. Post-CD inpatient opioid consumption, discharge opioid prescription amount, and sociodemographics were recorded from the electronic medical record. Women with opioid use disorder, wound complication, peripartum hysterectomy, general anesthesia for delivery, or readmission for infection or surgery were excluded. Patients were then contacted by phone approximately two weeks post-discharge to assess the status of their opioid tablets and their subjective pain control. Opioid amounts were recorded as Oxycodone 5 milligram (mg) tablets. Primary outcome was the association between inpatient opioid use and post-discharge opioid consumption. Secondary outcomes included disposition of tablets at two weeks post-discharge. Outcomes were analyzed using multivariable logistic regression between quartiles of inpatient and post-discharge opioid consumption.

After CD, inpatient opioid use predicted outpatient opioid use (r² = 0.25; p < 0.001): patients in the highest quartile of inpatient use (≥ 13 tablets) consumed a mean of 16.6 tablets as inpatients and 13.1 tablets as outpatients. The lowest quartile of inpatient opioid users (≤ 5 tablets) consumed a mean of 1.0 tablet as inpatients and 1.7 tablets as outpatients (t = 18.1, p < 0.001 and t = 7.8, p < 0.001, respectively). 80/110 (73%) of patients had leftover opioids, with only 5 patients (6%) disposing of their tablets.

The amount of tablets consumed post-CD as an inpatient is predictive of outpatient opioid consumption with minimal disposal of unused opioid tablets at two weeks post-discharge.