608 Predictors of post discharge opioid use after cesarean section

Abstract

To determine characteristics associated with post-cesarean outpatient opioid use. We conducted a prospective cohort analysis of women who underwent cesarean section at a single urban academic center from September 22, 2019 to March 11, 2020. Opioid use data was obtained via standardized phone surveys on post-discharge days three, seven, and fourteen. Demographic, hospital and surgery data was obtained from electronic medical records. Primary outcomes were post-discharge quantitative opioid use, and factors associated with increased use. Opioids were mathematically converted into morphine milligram equivalents (MME). Both Spearman’s correlation and Wilcoxon test examined association between total amount of outpatient opioid used, and patient and hospital factors. Secondary outcomes were length of post-discharge opioid use and use of non-opioid pain medications. Of 205 eligible patients who answered the phone, 190 (91%) agreed to participate and 173 (84%) participated in all three surveys. Median amount of opioid prescribed was 75 MME. 46.2% of patients (80/173) did not use opioids post-discharge. Median amount of total opioid used post-discharge was 15 MME, stratified to a median of 7.5 MME day 0-3, 0 MME day 4-7, and 0 MME day 8-14. Increased outpatient opioid use moderately correlated with increased in-hospital opioid consumption (r=0.3, p<0.0001), and weakly correlated with age (r=0.15, p=0.04), gravida (r=0.22, p=0.003), parity (r=0.21, p=0.005), number of previous cesarean (r=0.16, r=0.003) and amount of opioid prescribed (r=0.22, p=0.003). Patients used opioids for a median of two days post discharge. Patient use of non-opioid pain medication was not associated with narcotic use. Consistent with prior post-cesarean literature, opioids were prescribed in excess of consumption. A strategy to reduce overprescribing includes an algorithm for outpatient opioid prescriptions incorporating factors predictive of opioid use, including amount of opioid consumed in the hospital, age, gravida, parity and number of prior cesareans.View Large Image Figure ViewerDownload Hi-res image Download (PPT)