518 Association between cesarean skin incision selection and postoperative pain and opioid use

Abstract

Data are limited regarding the role of skin incision on postoperative pain and opioid use. This study evaluates post-discharge opioid use in patients with vertical versus transverse cesarean skin incisions. We conducted a secondary analysis of studies examining opioid use after cesarean from a single institution. All patients with data on opioid use and skin incision were included. Patients received surveys on postoperative days 1 and 14 about pain and opioid use. The primary exposure was vertical versus transverse incision and the primary outcome was post-discharge opioid use in morphine milligram equivalents (MME). Secondary outcomes included inpatient pain score (0-10), questions about pain control, need for additional opioid prescriptions, and duration and proportion of opioid used. Modified Poisson regression variance was used to calculate relative risks for categorical outcomes. Wilcoxan rank sum and multivariable linear regression were used to examine continuous outcomes. 591 women met inclusion criteria and 26 underwent vertical incision (1%). Women with a vertical incision were more likely to be Black or Hispanic, have public health insurance or a high school education or less, smoke, or have a higher BMI. They were prescribed and used more opioid MME at discharge, and were more likely to need additional opioid prescriptions (Table 1). Vertical incision was not associated with increased inpatient pain (p=0.67), however it was associated with increased outpatient opioid use. Also significantly associated with outpatient opioid use were medical comorbidities, prior cesareans, and total opioid prescribed at discharge. After adjusting for these covariates, vertical incision remained significantly associated with outpatient opioid use (Table 2), but not the need for additional opioid prescriptions. Vertical incision is associated with increased outpatient opioid use, independent of more opioids prescribed at discharge. Clinicians should weigh these risks when selecting skin incision.View Large Image Figure ViewerDownload Hi-res image Download (PPT)