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Correlation between in-hospital use of opioids post cesarean delivery and subsequent home prescriptions of hydromorphone
Abstract Number: F3A-195
Abstract Type: Original Research
Background & Objective
Prolonged opioid use and development of addiction is an increasingly recognized concern after cesarean section, as the overall incidence of addiction to opioids in women is rising . The amount of opioid prescribed at discharge from hospitals tends to exceed the amount needed/utilized by a significant margin, leading to leftover medication, susceptible to misuse . In a recent survey, 53% of women reported taking no pills, or less than 5, of the amount prescribed at discharge . The aim of this pilot project was to assess the correlation, if any, between in-hospital opioid use following cesarean delivery and the opioid prescription at discharge home at our university hospital.
After IRB approval, in a prospective observational cohort study, we collected data on patients undergoing cesarean delivery over a 10-week period at our tertiary-care hospital. Opioid consumption in hospital and opioid prescription at discharge home were recorded. The obstetrical team writing the prescriptions upon discharge was blinded as to which charts were reviewed.
Of the 131 patients reviewed, 78 received opioid prescriptions at discharge, 49 did not and 4 were unknown. Demographic data was similar among all. 20% of the patients using no hydromorphone in hospital received discharge prescriptions averaging 13.3mg (range 8-20mg). As the opioid use in hospital increased, the percentage of patients receiving prescriptions tended to parallel this increase, such that 100% of parturients using more than 15mg hydromorphone in hospital received a prescription upon discharge. The amount prescribed increased also to an average of 19.3mg (range 5-60mg). See Figure
While a small increase in the amount prescribed for home paralleled an increased in-hospital opioid use, a lack of titration of the amount prescribed was apparent. Indeed, 1 in 5 patients who received no hydromorphone in hospital left with a prescription. Given the potential harm associated with opioids, we must improve the tailoring of prescriptions to our post-cesarean patients.
1.Bateman BT. Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women. Am.J.Obstet. Gynecol. 2016;215:353.e1-353.e18
2.Osmundson SS. Postdischarge opioid use after cesarean delivery. Obstet.Gynecol. 2017;130:36–41
3.Bartels K. Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS One 2016;11