305: The effect of standardized discharge prescriptions on opioid use and pain experience after cesarean delivery

Abstract

To evaluate opioid use following cesarean delivery (CD) and determine the effect of standardized discharge prescriptions as part of an Enhanced Recovery After Surgery (ERAS) pathway on patients’ pain experience and opioid use. We conducted a baseline survey of women who underwent CD from Jan- March 2017 at an urban academic hospital. Patients were called after discharge to assess their pain and opioid use. In July 2017, we implemented an ERAS pathway, including consistent use of non-opioid pain medications and standardization of opioid prescriptions on discharge to ≤25 tabs of oxycodone. From Nov-Jan 2019, a post-implementation survey was conducted. Data was obtained from 102 women pre-implementation (PRE) and 104 women post-implementation (POST). On a 0-10 scale, mean reported pain scores at discharge were significantly lower in the POST group (PRE 6.61 vs POST 4.84, p=0.0001). 90% of discharge prescriptions were combined oxycodone/acetaminophen PRE, compared to 90% oxycodone alone POST. In the PRE group, 96% of patients were prescribed ≥30 pills, whereas POST, 97% were prescribed ≤25 pills. The mean number of pills consumed was significantly lower PRE vs. POST (24 vs 16, p=0.001). The number of patients who consumed all pills prescribed (43% vs 40%, p=0.691) and the mean number of leftover pills (7 vs 7, p=0.832) were not different between groups. Number of pills consumed was not associated with any patient factors, but was associated with pills prescribed. For each additional pill prescribed, 0.467 more pills were consumed (p< 0.05). Refills did not differ between groups (6% vs 3%, p=0.786). Mean pain scores the week after discharge were lower in the POST group, at 4.0 vs 3.3, p=0.02. Implementing an ERAS pathway with standardized discharge prescriptions after CD led to a significant decrease in the mean number of opioid pills taken while also improving patients’ reported pain. The similar number of unused pills in both groups suggests that even fewer pills could be prescribed. Standardized discharge prescriptions should be incorporated into ERAS protocols.