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Opioid Prescription/Patient Use Mismatch: Prospective Cohort Study of Post-Discharge Opioid Use Following Cesarean
Abstract Number: F-13
Abstract Type: Original Research
AIM: To compare opioids prescribed and opioids used by women following discharge after cesarean delivery (CD).
METHODS: After IRB approval, all women undergoing CD over an 8 week period, without major chronic opioid use or peri-op morbidity, were recruited. Subjects were enrolled/surveyed on post-op day (POD) 1-2. Information on demographics, CD, and in-hospital opioid and non-opioid analgesic use was drawn from the medical record. Subjects were surveyed on POD 14 to assess post-op pain and quantify analgesic use. The TN Controlled Substance Monitoring Program was accessed to confirm that prescriptions were filled. All opioid use comparisons were made using morphine milligram equivalents (MME). The high post-discharge opioid use group (top quartile) was compared to average opioid use group (remainder). Multivariable logistic regression was used to evaluate associations between high MME use and variables found to be associated in univariate analysis. Manual backward elimination was used to select a model that retained only those variables significant at the 0.05 significance level.
RESULTS: Of 286 CDs during the study period, 251 met inclusion eligibility. Of these, 246 participated. Complete data were available for 179, or 72% (Figure). Post-discharge prescribing practices were highly variable (60 to 630 MME). Most women (83%) used opioids after discharge, and for a median of 8 days (IQR 6-13 days). Of 165 women who filled their prescriptions, 125 (76%) had leftover pills (75 MME [IQR 0-187, max 630]). Most 77 (61%) reported keeping leftover pills in unsecured locations at home. Women who used all prescribed opioids were more likely to report that they received too few pills than women who used some or no prescribed opioids (33% vs 5%, p<0.05). Compared to the average post-discharge opioid use group, the high use group had greater in-hospital opioid MME use overall (103 +/- 51 vs 67 +/- 53, P<0.001), per hour (1.5+0.7 vs 0.9+0.7, <0.001), and during the 2nd, 3rd, and 4th 12-hour post-op epochs (P<0.001 for each comparison). Excess prescribed opioids totaled 19,046 MME for these 179 patients, equivalent to 2,540 unused oxycodone 5mg tablets (est. 16,500/yr).
CONCLUSION: Despite variable opioid prescription practices, most patients are prescribed far more than they use after discharge. Our results suggest that considering in-hospital opioid use to individualize post-discharge opioid prescriptions may help reduce excessive opioid prescribing practices.