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Hospital variation in administration of oral opioid medication during vaginal delivery hospitalizations
Abstract Number: T5A-5
Abstract Type: Original Research
Currently, there is limited data on hospital opioid prescribing during vaginal delivery (VD) hospitalizations. Recently the U.S. FDA warned against the use of codeine or tramadol during breastfeeding. Breastfeeding safety experts have also expressed concern regarding higher doses of oxycodone and breastfeeding. The purpose of this study was to characterize oral opioid medication use during VD hospitalizations.
An administrative inpatient database that includes medications was analyzed to evaluate use of short acting oral opioid medications during VD hospitalizations from January 2006 through March 2015. Hospital level rates of opioid administration during VD hospitalizations were calculated. Demographic, obstetric, and hospital factors associated with receipt of any opioids and specifically with receipt of codeine were calculated. Mixed effects log-linear regression models for receipt of (i) all opioids and (ii) codeine were created.
3,090,191 VD hospitalizations meeting criteria were included in the analysis. 52.2% of women received an opioid medication; of these 21.4% received codeine. The Figure demonstrates significant variation in opioid administration by hospital. Patients in the South were more likely to receive opioids than the East (61.3% vs. 38.5%, P<0.001). In adjusted models 3rd/4th degree lacerations and operative VD were associated with increased receipt of opioids (risk ratio [RR] 1.18, 95% confidence interval [CI] 1.16-1.20, RR 1.26 95% CI 1.24-1.28, respectively). Adjusted likelihood of codeine use decreased over the study period with RR 0.62 (95% CI 0.48-0.82) in 2015 with 2006 as the referent.
Opioid use varied significantly by hospital and region suggesting many centers may be able to reduce opioid use by optimizing pain management strategies. Use of codeine decreased significantly over the study period supporting that other agents without similar breastfeeding concerns may be effective. Nationally, pain management after vaginal delivery may be meaningfully improved by quality improvement initiatives.