Poster Session 1
Ruth Landau, MD (she/her/hers)
Virginia Apgar Professor of Anesthesiology
Columbia University
New York, NY, United States
Uma M. Reddy, MD, MPH (she/her/hers)
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
To evaluate opioid use after cesarean delivery (CD) and assess our hypothesis that no in-hospital opioid use is associated with no post-discharge opioid use, and to evaluate the association between no opioid use and post-discharge pain.
Study Design:
Secondary analysis of a multicenter trial in patients who underwent CD at 31 U.S. hospitals (2020-22) and were randomized to individualized or fixed quantity of opioid tablets at discharge. The exposure was no in-hospital opioid use (morphine milligram equivalents [MME]=0). Primary outcome was post-discharge MME=0 up to 90 days. Secondary outcomes were moderate to severe pain (Brief Pain Inventory [BPI] score; BPI worst pain ³ 4 at 1-, 2- and 6-weeks post-discharge), opioid prescriptions filled, and refills within 90 days. MMEs included all routes of administration. Univariable modeling estimated the association between in-hospital MME=0 and outpatient opioid use, as well as pain.
Results:
Of 5515 eligible participants, in-hospital MME=0 rate was 19% (N=1023) and post-discharge MME=0 rate was 34% (N=1752). Overall, 710 of the 1,023 of the participants (76%) who did not use opioids in-hospital used none post-discharge, though 54% filled a prescription for opioids at or after discharge. In-hospital MME=0 was associated with lower post-discharge opioid use, higher odds of MME=0 (OR 9.8, CI 8.3, 11.5) and lower median MME dose (0 vs 7) (Table 1). With post-discharge MME=0, the proportion of participants with moderate to severe pain was significantly lower at 1 week (42% vs. 70%), 2 weeks (20% vs. 38%), and 6 weeks (6% vs. 14%, all p< 0.001).
Conclusion:
Consistent with our hypothesis, in-hospital opioid use was associated with post-discharge opioid use. Though one-third of participants did not use any opioids post-discharge, this was not associated with higher pain scores at any time point up to 90 days post-discharge. Further efforts are needed to align opioid prescriptions with actual post-discharge opioid use.
