To identify patient and health care provider characteristics associated with receipt of a high amount of prescribed opioids at postpartum discharge.
This was a retrospective case–control study of all opioid-naïve women delivering at a single, high-volume tertiary care center between December 1, 2015, and November 30, 2016. Inpatient, outpatient, pharmacy, and billing records were queried for clinical, prescription, and health care provider (training, age, gender) data. The discharging health care provider, whether an opioid prescription was provided, and the details of any opioid prescription were determined. A high amount of prescribed opioids was defined as morphine milligram equivalents greater than the 90th percentile (determined as 300 morphine milligram equivalents for vaginal and 500 morphine milligram equivalents for cesarean delivery). Multivariable logistic regression models with random effects were used to identify patient and health care provider factors independently associated with receipt of a high amount of prescribed opioids at discharge. Findings were analyzed separately by mode of delivery.
The analysis included 12,362 women. High amounts of opioids were prescribed for 636 of 9,038 (7.0%) women who delivered vaginally and 241 of 3,288 (7.3%) of those delivering by cesarean. In multivariable analysis, patient factors associated with receipt of a high amount of prescribed opioids at discharge after a vaginal delivery included nulliparity, intrapartum neuraxial anesthesia, major laceration, and infectious complication. Discharge by a trainee physician was associated with decreased odds of receiving a high amount of opioids (8.5% vs 1.9%; adjusted odds ratio [OR] 0.08, 95% CI 0.01–0.53). For women who underwent cesarean delivery, the only patient factor associated with receipt of a high amount of prescribed opioids was hemorrhage. Discharge by a trainee physician was associated with decreased odds of being provided a high-amount opioid prescription (7.9% vs 0.4%; adjusted OR 0.01, 95% CI 0.00–0.36).
Even after adjusting for patient factors, discharge by a trainee physician is significantly associated with decreased odds of a high amount of prescribed opioids at postpartum discharge.
Postpartum hospital discharge by a trainee physician is significantly associated with decreased odds of receipt of a prescription for a high amount of opioids.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Corresponding author: Nevert Badreldin, MD, 250 E Superior Street, #5-2175, Chicago, IL 60611; email: firstname.lastname@example.org.
Each author has indicated that he or she has met the journal's requirements for authorship.
Financial Disclosure The authors did not report any potential conflicts of interest.
Presented as a poster at the 2018 Society of Maternal-Fetal Medicine 38th Annual Meeting, January 29–Feburary 3, 2018, Dallas, Texas.
Lynn M. Yee is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development K12 HD050121-11. Also supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422, and by the Society for Maternal-Fetal Medicine/AMAG 2017 Health Policy Award. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Received April 03, 2018
Received in revised form June 14, 2018
Accepted July 05, 2018