MFM Fellow The Ohio State University Columbus, Ohio, United States
Objective: To evaluate the association between cesarean delivery (CD) characteristics, opioid use, and post-operative pain scores among patients who underwent CD.
Study Design: Secondary analysis of a multicenter randomized trial of individuals who underwent CD across 31 U.S. hospitals from 2020-2022. Primary outcome was total in-hospital postoperative morphine milligram equivalents (MME). Secondary outcomes included total postoperative in-hospital MME per day, total number of opioid tablets through 90 days post-discharge, and moderate-severe perceived pain (defined as worst pain score of ≥4 of 10 on Brief Pain Inventory (BPI)) assessed at randomization (within one day prior to discharge). CD characteristics included scheduled or unscheduled; whether done in the presence of labor or not; and primary or repeat. Multivariable modeling estimated the association between CD characteristics and selected outcomes adjusting for age, obesity, and insurance status.
Results: The 5477 participants included in this analysis were categorized into 6 mutually exclusive groups (Table 1). Labor before scheduled CD was excluded due to low frequency (n=38). Age, BMI, insurance status, concurrent salpingectomy, postpartum hemorrhage, and birthweight differed significantly between groups (data not shown). In the simple multivariable model, total inpatient MME was greater after repeat CD without labor, whether scheduled or unscheduled; in adjusted analyses there was no association between CD characteristics and primary outcome (Table 2). Repeat CD was associated with a greater number of daily opioid tablets taken postoperatively until discharge (aOR 1.2, 95% CI 1.06, 1.4), total number opioids taken post-discharge (aOR 1.2, 95% CI 1.1-1.4) and increased moderate-severe pain (aOR 1.4, 95% CI 1.1, 1.4) compared with primary CD.
Conclusion: The total in-hospital postoperative MME did not differ by any of the evaluated CD characteristics. However, repeat CD was associated with more inpatient opioid use per day, outpatient opioid use, and moderate-severe perceived pain.
