Variation in Postdischarge Opioid Prescribing After Childbirth and Associated Procedures

Area of Science:

• Obstetrics and Gynecology
• Pain Management
• Health Services Research

Background:

• Current postpartum pain management guidelines lack specific opioid prescribing recommendations for vaginal births with associated procedures.
• Opioid prescribing practices after operative vaginal birth and severe perineal lacerations are not well-defined.

Purpose of the Study:

• To assess variations in hospital-level opioid prescribing rates and amounts for patients after vaginal births with associated procedures.
• To identify opportunities for standardizing opioid prescribing in the postpartum period.

Main Methods:

• Retrospective cohort study of 14,690 opioid-naive, nulliparous patients across 67 hospitals.
• Adjusted logistic regression models used to analyze between-hospital variation in opioid prescribing.
• Opioid prescribing rates and amounts (oral morphine equivalents - OMEs) were examined for operative vaginal births and third- or fourth-degree lacerations.

Main Results:

• Overall, 1.8% of patients received an opioid prescription, with a median of 60 OMEs.
• Opioid prescription rates were higher for third- or fourth-degree lacerations (11.6%) compared to routine vaginal birth.
• Prescription amounts were highest for operative birth (median 75 OMEs).
• Significant hospital-level variation observed in prescribing rates (0-66.7% for lacerations) and amounts (25-135 OMEs for operative birth).

Conclusions:

• Opioid prescribing is more common after vaginal births with associated procedures than routine vaginal births.
• Marked variation exists among hospitals in postpartum opioid prescribing, indicating a need for standardization.
• Standardized guidelines are crucial for optimizing postpartum pain management and reducing opioid exposure.