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Am J Perinatol 2024; 41(S 01): e2934-e2940
DOI: 10.1055/a-2184-0423
Original Article

Reducing Opioid Prescribing after Cesarean Delivery by Utilizing a Tailored Opioid Prescribing Algorithm

Christine P. McKenzie 
1   Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
,
Lacey E. Straube
1   Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
,
Carolyn M. Webster
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Matthew E. Nielsen
3   Department of Urology, University of North Carolina, Chapel Hill, North Carolina
,
Alison M. Stuebe
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
4   Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
› Author Affiliations Funding The work was supported by the University of North Carolina Institute of Healthcare Quality Improvement's Improvement Scholars Program and internal departmental funds.
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Abstract

Objective There are increasing efforts among health care systems to promote safe opioid prescribing; however, best practice for minimizing overprescription is not established. Our study aimed to evaluate the effect of a tailored opioid prescribing algorithm on opioid prescription quantities.

Study Design A tailored opioid prescribing algorithm was developed to provide a recommended prescription quantity based on inpatient opioid use. A retrospective analysis of opioid prescribing 3 months before and after implementation was performed. Our primary outcome was the number of oxycodone 5-mg tablets prescribed. Subgroup analysis by oxycodone consumption in the 24 hour prior to discharge was performed. Patient satisfaction and unused opioid tablets were assessed by text message survey 2 weeks' postpartum.

Results We included 627 (n = 313 preimplementation; n = 314 postimplementation) patients who underwent cesarean delivery. Clinical characteristics were similar between groups. The median number of oxycodone 5-mg tablets prescribed in the baseline group was 20 (interquartile range [IQR]: 20–30), compared with 5 (IQR: 0–10) in the tailored prescribing group (p < 0.0001). For patients with no opioid use in the 24 hours prior to discharge, the median number of tablets prescribed decreased from 20 (IQR: 10–20) to 0 (IQR: 0–5) following the intervention (p < 0.0001). The proportion of patients discharged without an opioid prescription increased from 7% (23/313) in the baseline group to 35% (111/314) in the tailored prescribing group (odds ratio: 6.9, 95% confidence interval [4.3, 11.1]).

Conclusion Tailored opioid prescribing reduced the number of opioid tablets prescribed and increased the proportion of patients who were discharged without an opioid prescription.

Key Points

  • Opioid prescribing should be tailored by inpatient use.

  • Tailored prescribing reduced opioid prescription amounts.

  • Many patients do not require an opioid prescription.

Keywords

cesarean delivery - obstetrics - opioid - opioid consumption - opioid prescription - opioid stewardship - quality improvement - cesarean analgesia


Publication History

Received: 26 April 2023

Accepted: 26 September 2023

Accepted Manuscript online:
29 September 2023

Article published online:
14 November 2023

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