Cesarean section is the most common major surgery among women in the United States. Guidance on how much opiate medication women need after hospital discharge is unavailable. Our objective was to determine if factors such as amount of opioid medication used inpatient relate to outpatient opioid use.
We conducted a prospective cohort study of women after cesarean delivery. Patient demographic and clinical characteristics (including opioid usage and prescriptions) were collected by survey at enrollment. Between 2-5 weeks post-hospital discharge we obtained self-reported opioid usage information. Medical records were reviewed for additional clinical data. Opioid usage was standardized to Morphine Equivalent Doses (MED) and tertiles of MED were generated for analyses. T-test and ANOVA were used for comparison of MED between groups, and Pearson correlation coefficients evaluated MED correlation between inpatient factors and outpatient use.
One hundred participants were enrolled; 76 completed follow-up. On average, participants used 59 MED (±43) in the final 24 hours inpatient and 258 MED (±57) per patient were prescribed for outpatient use. Among women completing follow-up, 21% used all opioids prescribed and 20% used none. Overall, 53% of opioid pills prescribed were not taken. Maternal history of psychiatric comorbidities was associated with higher outpatient opiate use (172 MED vs 103 MED; p= 0.046). As inpatient MED use increased across the three MED tertiles (<40, 41-70, >70), there was an association with increased outpatient opiate use (difference between groups p<0.001, correlation r=0.429, p<.001).
Not all opioids prescribed following cesarean section are taken within 5 weeks of hospital discharge. We demonstrate that inpatient opioid use correlates with the number of opioids used outpatient and may be a factor clinicians could consider when providing hospital discharge prescriptions. Prescribing an appropriate amount of post-cesarean opioids is a tangible way obstetricians could impact the public health crisis of opioid abuse.
Women and Infants Hospital, Alpert Medical School, Brown University, Providence, RI
Financial Disclosure: The authors did not report any potential conflicts of interest.