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Opioid use disorder and maternal outcomes following cesarean section; a multi-state analysis
Abstract Number: F3A-398
Abstract Type: Original Research
Opioid use disorder is a public health crisis in the United States, with an overdose mortality rate of more than 63,000 in 2016(1). Opioid abuse poses significant maternal and fetal risks, including intrauterine growth restriction, placental abruption, preterm delivery and neonatal abstinence syndrome(2). Recent research examining the association of maternal opioid use with maternal mortality and morbidity, as well as fetal outcomes, showed an increase in maternal death during hospitalization, cardiac arrest, and obstetric complications (3). There are no current studies that investigate maternal complications in a national cohort of patients with opioid use disorder who undergo cesarean delivery. Using data from the State Inpatient Database (SID), we examined the rates of maternal mortality and other post-delivery outcomes associated with opioid abuse among women undergoing cesarean delivery.
We performed a retrospective analysis of women who underwent cesarean delivery in California, Florida, New York, Maryland, and Kentucky (age 18+) using SID years 2007-2014. For our study outcomes of interest – inpatient mortality (primary), hospital length of stay, readmissions, and total monetary charges (secondary) – we compared both unadjusted rates and adjusted odds ratios (aOR) calculated through separate multivariate models. We conducted our data analysis using SAS 9.4 and Stata SE 15.
In our five state cohort (2007-2014), 2,425,527 women underwent cesarean deliveries; of those, 10,703 (0.4%) were identified as having opioid use disorder. Women identified as having any prior opioid abuse had an increased aOR of inpatient mortality (aOR 2.48; 95%CI 1.20-1.50), increased 30-day (aOR 1.46; 95%CI 1.30-1.65), 90-day (aOR 1.70; 95%CI 1.55-1.88) readmissions, length of stay (IRR 1.02; 95%CI 1.00-1.04), and increased total charges (aIRR 1.05; 95%CI 1.03-1.07).
We examined a five-state database to evaluate the number of women undergoing cesarean sections and found that women with opioid use disorder experienced increased inpatient mortality, length of stay, readmissions, and total charges. The opioid epidemic continues to be a public health crisis. With the increasing number of reproductive-age and pregnant women affected by opioid use disorder, it is essential to further understand its implications during pregnancy, as well as the postpartum period. We acknowledge that our findings are retrospective and observational and may be limited to cesarean deliveries. However, they highlight the need for further research to show the implications of opioid use disorder on maternal and fetal outcomes.
2. Stover MW et al. Opioids in pregnancy and neonatal abstinence syndrome. Seminars in Perinatology Nov 2015
3. Maeda A. et al. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology Dec 2014