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Correlation between women’s oxycodone intake after cesarean delivery and opioid prescriptions: are we overprescribing?
Abstract Number: F3A-246
Abstract Type: Original Research
Opioid use after surgery is the focus of recommendations aiming at reducing unnecessary in-hospital opioid use,1 overprescribing at discharge,2,3 risk for persistent use 4 and potential misuse. Opioid prescription (OP) patterns after cesarean delivery (CD) are far in excess of what women actually take at home,2 and are not based on what women took in the last 24h before discharge.3 Several initiatives promoting opioid-sparing analgesia after CD were implemented end of 2017 in our institution, we thus decided to examine trends in women’s in-hospital oxycodone use as well as the OP they were sent home with.
Using an institutional QA/QI Opioid Dashboard, data was collected from all CD cases in 2018 (cases with prolonged stay>80h after delivery were excluded). Prescribers' characteristics and prescription patterns were recorded. For each CD, in-hospital oxycodone use (overall and during last 24h), OP (yes/no) and number of prescribed pills (oxycodone/Percocet 5mg) were noted. Overprescription was defined when a woman took no opioids in the last 24h but received an OP at hospital discharge; linear regression model was applied to assess correlation.2
In 2018, 456/1503 (30.3%) women took no opioids after their CD; 89% received an OP at discharge (Fig A-B). There were 817 women (54.4%) who took no opioids in the last 24h, but 750 (91.8%) of them received an OP at discharge (Fig A). Overprescription occurred in 49.9% of the cohort (750/1503); there was no linear relationship between intake and OP (r2=0.09439, correlation 0.3; Fig D). Prescribers and OP patterns are presented (Table). The average in-hospital opioid intake per patient was 4.5 oxycodone pills (22.5mg), with an average 2.8 pills (14 mg) among those using opioids in the last 24h (N=686); the average number of prescribed pills at discharge was 19.5 (97.5mg) (Fig C)
There was no correlation between the oxycodone intake in the last 24h and prescriptions women went home with, resulting in opioid overprescription in 50% of women undergoing a CD in 2018 in our institution. With an average prescription of 20 pills per patient, there may be up to 15,000 leftover pills in our patients’ homes last year. We identified an urgent need for additional interventions to help prescribers achieve tailored prescriptions based on women’s individual profile.
1. Obstet Gynecol 2019; 133:91–7
2. Obstet Gynecol 2017;130:29-35
3. JAMA Surgery 2018;153(2)
4. JAMA Surgery 2017;152(6)