667 Inpatient opioid consumption after cesarean delivery in patients with mood disorders

Abstract

To examine the association between diagnosis of a mood disorder (MD) and inpatient opioid consumption after cesarean delivery (CD). A retrospective cohort study of patients who delivered by CD between 2014 and 2019 was performed. Exposure was determined by maternal diagnosis of MD, defined as depression and/or anxiety. The primary outcome was inpatient opioid consumption after the first 24 hours postpartum, standardized to morphine milliequivalents per hour (MME/hr). Hourly, rather than total MME, was chosen as the primary outcome to standardize opioid consumption across patients with varying lengths of stay. Secondary outcomes included highest dose of oxycodone required and highest/lowest quartile of MME/hr consumption. Univariable and multivariable analyses were done to examine the associations between maternal MD and the primary and secondary outcomes, controlling for sociodemographic characteristics, clinical obstetric factors, and non-opioid analgesic intake postpartum. Of 1,620 eligible patients, 384 (23.7%) were identified as having MD. Patients with MD were more likely to be single, use tobacco, use illicit substances in pregnancy, undergo a tubal ligation, and have a hemorrhage at delivery (Table 1). In univariable analysis, the rates of the primary outcome, MME/hr, were significantly higher among patients with MD compared to controls (Table 1). After controlling for confounders, this finding did not persist (Table 2). However, in regard to the secondary outcomes, patients with MD were more likely to require higher doses of oxycodone at a time, i.e. ≥10 mg vs. <10 mg (aOR 1.38, 95% CI 1.07-1.79). In addition, patients with MD were more likely to be in the highest quartile of MME/hr opioid consumption (aOR 1.75, 95% CI 1.34-2.29) and less likely to be in the lowest quartile (aOR 0.63, 95% CI 0.47-0.86) (Table 2). Maternal diagnosis of MD was not associated with higher hourly consumption of MME during inpatient stay after CD. However, diagnosis of MD was associated with increased requirement of higher oxycodone doses.View Large Image Figure ViewerDownload Hi-res image Download (PPT)