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Factors associated with inpatient opioid use after vaginal delivery
Abstract Number: T5A-2
Abstract Type: Original Research
Objective: Although non-opioid medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (APAP) are considered first line for pain, the extent to which opioids are used throughout the postpartum (PP) hospitalization following vaginal delivery (VD) is unknown. Our objectives were to determine factors associated with opioid use during the last 24hrs of PP hospitalization following a) any VD and b) uncomplicated VD.
Study Design: Retrospective case control study of women who underwent VD at a single tertiary care center (12/2015-16). Inpatient, pharmacy and administrative records were queried for clinical and prescriber data. Opioid use during the last 24hrs of the PP hospitalization was determined. Significant factors on bivariable analysis were assessed in multivariable logistic regression with random effects to identify patient and provider factors associated with opioid use. A secondary analysis of women who underwent uncomplicated VD, defined as lack of intrapartum, PP or neonatal complications, was performed.
Results: In this cohort of 9076 women post VD, 97.1% utilized NSAIDs, 25.8% utilized APAP and 26.1% utilized opioids (+/- APAP co-formulary) during last 24hrs of the PP hospitalization. In multivariable analysis, factors associated with increased odds of opioid use included higher body mass index (BMI), history of smoking or substance abuse, VBAC, operative VD, epidural use, or PP hemorrhage (Table). Factors associated with decreased odds of inpatient opioid utilization included Asian race and care by a midlevel provider. Notably, greater use of APAP and NSAID was associated with decreased odds of opioid use. Even when restricted to women with uncomplicated VD, nearly a quarter (22.3%, n=1247) received inpatient opioids during the last 24hrs of hospitalization. BMI and epidural use were associated with increased odds, whereas nulliparity, Asian race, care by midlevel provider, and greater use of APAP or NSAIDs were associated with decreased odds (Table).
Conclusion: After VD, inpatient opioid use to the end of the PP hospital stay is common, even among women with no peripartum complications. After adjustment for patient and provider characteristics, greater use of non-opioid analgesics was associated with decreased odds of opioid use, highlighting the potential for a greater reliance on these first line modalities to assist in reduction of opioid use for PP pain.