Inpatient opioid use after vaginal delivery

Abstract

More than half of patients hospitalized annually receive an opioid during their inpatient hospitalization, which may serve as a first opioid exposure. Although recent research addresses outpatient opioid prescribing following delivery, little is known regarding the extent to which opioids are used during the postpartum hospitalization following vaginal delivery. Our objectives were as follows: (1) to describe the use of opioids during the last 24 hours of postpartum hospitalization in women following vaginal delivery and (2) to identify patient and provider characteristics associated with the use of opioids during this time period. This is a retrospective case-control study of women who underwent vaginal delivery at a single tertiary care center from Dec. 1, 2015, to Nov. 30, 2016. Inpatient, pharmacy, and administrative records were queried for clinical and inpatient prescriber data. Opioid use during the last 24 hours of the postpartum hospitalization was determined. Significant factors on bivariable analysis were assessed in multivariable hierarchical logistic regression with random effects to identify patient and provider factors associated with any opioid use. A subgroup analysis of women who underwent an uncomplicated vaginal delivery, defined as lack of intrapartum, postpartum, or neonatal complications, was performed. In this cohort of 9038 women after a vaginal delivery, almost a quarter (n= 2242, 24.8%) utilized opioids during the last 24 hours of the postpartum hospitalization. In a multivariable analysis, several patient characteristics were associated with increased odds of opioid use during the last 24 hours of admission, including higher body mass index, history of smoking and substance abuse, use of regional analgesia, vaginal birth after cesarean delivery, major laceration, postpartum hemorrhage, and infectious complication. Even after adjusting for these characteristics, greater use of acetaminophen (adjusted odds ratio, 0.81, 95% confidence interval, 0.77-0.85) and analgesia orders written by an advanced practitioner (adjusted odds ratio, 0.46, 95% confidence interval, 0.29-0.73) remained associated with decreased odds of using an opioid. The same 2 factors remained associated with less opioid use (acetaminophen doses [adjusted odds ratio, 0.86, 95% confidence interval, 0.81-0.92] and analgesia orders written by an advanced practitioner [adjusted odds ratio, 0.52, 95% confidence interval, 0.30-0.89]) when only women who had an uncomplicated vaginal delivery were analyzed. In a large cohort, nearly one-quarter of women use opioid analgesia during the last 24 hours of inpatient hospitalization following vaginal delivery. Although patient factors account for some of the variation in inpatient opioid use, both use of acetaminophen and having had postpartum orders written by an advanced practitioner were independently associated with lower odds of inpatient opioid use.