Abstract
Objective This study aims to determine if adoption of a user-friendly algorithm for individualized
opioid prescribing at discharge would decrease the number of opioids prescribed after
cesarean delivery.
Study Design As part of a quality initiative, we developed and implemented an algorithm for opioid
prescribing at discharge for patients after cesarean delivery. The intervention group
comprised patients delivering by cesarean in the 6 months following initiation of
the intervention. The intervention group was divided into three groups based on inpatient
opioid needs 24 to 48 hours after delivery. Oxycodone tablets were prescribed at discharge
based on inpatient group. The control group comprised patients delivering at the same
institution in the 6 months prior to initiation of the intervention. The primary outcome
was number of oxycodone tablets prescribed at discharge. The secondary outcome was
the proportion of patients with a pain-related encounter or additional oxycodone prescription
up to 6 weeks after delivery.
Results From July to December 2020, a total of 382 subjects met criteria for the intervention.
The comparison group consisted of 391 subjects discharged from January to June 30,
2020, after cesarean. Baseline characteristics and inpatient opioid use 24 to 48 hours
after delivery did not differ between the groups. Compared with the control group,
subjects in the intervention group had fewer oxycodone tablets prescribed at discharge
(11.1 vs. 15.8, p < 0.001). The number of pain-related encounters within 6 weeks of delivery did not
differ between the intervention and comparison groups (10.5 vs. 10.3%, p = 0.82). There was no increase in the additional number of oxycodone prescriptions
after discharge (4.7% in the intervention group vs. 4.3% in the control group, p = 0.81).
Conclusion Discharge opioid prescribing based on inpatient use after cesarean reduces the number
of opioids prescribed without increasing the number of pain-related encounters after
discharge. A simple algorithm may ensure compliance from prescribers.
Key Points
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Previous research has shown that most opioids prescribed after cesarean delivery are
unused after discharge. We implemented an algorithm for opioid discharge prescribing
after cesarean delivery based on inpatient opioid consumption.
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Implementing an individualized approach to opioid prescribing reduced the number of
tablets prescribed at discharge after cesarean delivery. The decrease in discharge
prescribing did not correspond to an increase in pain-related encounters or additional
narcotic prescriptions in the 6 weeks following delivery.
-
The overprescription of opioids at discharge after cesarean delivery is well-established,
and previous authors have found success in prescribing opioids at discharge based
on inpatient use. Our study proposes a simple, reproducible algorithm for opioid prescribing
at discharge after cesarean.
Keywords
cesarean delivery - cohort - enhanced recovery - opioid prescribing - opioids - quality
improvement
