141: Long acting opioid use during delivery hospitalizations and risk for severe maternal morbidity

Abstract

Currently, there is limited data on long acting opioid (LAO) use during delivery hospitalizations including whether women using these medications are at increased risk for severe maternal morbidity (SMM). The objectives of this study were: (i) to assess use of and hospital variation in LAOs during delivery hospitalizations, and (ii) determine risk for SMM among LAO users. An administrative inpatient database that includes medications was analyzed to evaluate use of LAOs during delivery hospitalizations from January 2006 through March 2015. Medications included extended-release formulations of oxycodone and morphine, buprenorphine, and methadone. Hospital level rates of LAO administration during delivery hospitalizations were calculated. Unadjusted and adjusted models evaluating the role of demographic and hospital factors were created. Risk for SMM was determined based on CDC criteria. 4,653,945 delivery hospitalizations meeting criteria were included in the analysis. 1.2% of women received a LAO during their hospitalization. Risk of SMM was significantly higher for women receiving a LAO compared to other women (3.0% vs. 1.6% p<0.001). The Figure demonstrates rates of LAO use by hospital. Of 497 hospitals, rate of LAO receipt was ≤0.1% for 158 hospitals, >0.1% and <1.0% for 254 hospitals, and ≥1.0% for 85 hospitals; this latter group accounted for majority of LAO use. In adjusted analyses, LAO use was more common among older women, white women, Medicaid recipients, and single women (Table). LAO use varies significantly by center and is associated with an increased risk for SMM. Given that a small proportion of centers provide care for the majority of women using these medications, it may be possible to improve care and safety via targeted interventions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)