Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2025
Predictors of In-Hospital Opioid Consumption and Discharge Prescribing Following Cesarean Delivery.
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Dmowski Katy, Do Uyen, Cutler Danielle, Ghezeljeh Tahereh Najafi, Khorasani Elahe, Kaneva Pepa, Ramanakumar Agnihotram V, Feldman Liane S, Zakhari Andrew, Fiore Julio F
Аннотация
OBJECTIVES: This study aimed to assess the extent to which patient and care characteristics are associated with in-hospital opioid consumption and discharge prescribing following cesarean delivery (CD).
METHODS: This retrospective cohort study included patients undergoing CD under neuraxial anesthesia at a university-affiliated hospital from December 2020 to December 2021. Patient demographics, care characteristics, in-hospital opioid consumption, and discharge prescription (in number of morphine 5 mg pills) were collected from medical records. Predictors were analyzed using negative binomial regression, with multiple imputations for missing data.
RESULTS: Overall, 904 patients were included (age 35 ± 5 years, gestational age 380 ± 26 weeks, multiple gestations 5.3%, previous CD 44.7%, emergency delivery 40.9%, and hospital stay 2.3 ± 1.1 days). In-hospital analgesia prescriptions included acetaminophen (100%), nonsteroidal anti-inflammatory drugs (91.2%), and opioids (100%). Median in-hospital opioid consumption was zero (IQR 0-2) morphine 5 mg pills. Opioid consumption was associated with opioid use during pregnancy (incidence rate ratio [IRR] 9.419; 95% CI 3.425-25.900), higher postoperative pain scores (IRR 1.599; 95% CI 1.524-1.678), higher post-anesthesia care unit opioid consumption (IRR 1.007; 95% CI 1.002-1.013), and nonsteroidal anti-inflammatory drugs consumption (IRR 0.613; 95% CI 0.460-0.818). At discharge, 89.2% of patients were prescribed opioids (median = 20 [IQR 20-20] morphine 5 mg pills). Decreased discharge prescribing was associated with receiving a preprinted discharge prescription with fewer morphine 5 mg pills (10 vs. 20; 0.548 [95% CI 0.389-0.770]).
CONCLUSIONS: In this study, in-hospital opioid consumption following CD was low and was associated with patient and care-related factors. At discharge, the only factor associated with prescription size was the use of preprinted prescriptions. These findings can inform strategies to mitigate opioid-related harms following CD.
METHODS: This retrospective cohort study included patients undergoing CD under neuraxial anesthesia at a university-affiliated hospital from December 2020 to December 2021. Patient demographics, care characteristics, in-hospital opioid consumption, and discharge prescription (in number of morphine 5 mg pills) were collected from medical records. Predictors were analyzed using negative binomial regression, with multiple imputations for missing data.
RESULTS: Overall, 904 patients were included (age 35 ± 5 years, gestational age 380 ± 26 weeks, multiple gestations 5.3%, previous CD 44.7%, emergency delivery 40.9%, and hospital stay 2.3 ± 1.1 days). In-hospital analgesia prescriptions included acetaminophen (100%), nonsteroidal anti-inflammatory drugs (91.2%), and opioids (100%). Median in-hospital opioid consumption was zero (IQR 0-2) morphine 5 mg pills. Opioid consumption was associated with opioid use during pregnancy (incidence rate ratio [IRR] 9.419; 95% CI 3.425-25.900), higher postoperative pain scores (IRR 1.599; 95% CI 1.524-1.678), higher post-anesthesia care unit opioid consumption (IRR 1.007; 95% CI 1.002-1.013), and nonsteroidal anti-inflammatory drugs consumption (IRR 0.613; 95% CI 0.460-0.818). At discharge, 89.2% of patients were prescribed opioids (median = 20 [IQR 20-20] morphine 5 mg pills). Decreased discharge prescribing was associated with receiving a preprinted discharge prescription with fewer morphine 5 mg pills (10 vs. 20; 0.548 [95% CI 0.389-0.770]).
CONCLUSIONS: In this study, in-hospital opioid consumption following CD was low and was associated with patient and care-related factors. At discharge, the only factor associated with prescription size was the use of preprinted prescriptions. These findings can inform strategies to mitigate opioid-related harms following CD.