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

Christine P. McKenzie; Lacey E. Straube; Carolyn M. Webster; Matthew E. Nielsen; Alison M. Stuebe

doi:10.1055/a-2184-0423

American Journal of Perinatology, Table of Contents

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

¹Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina

,

Lacey E. Straube

¹Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina

,

Carolyn M. Webster

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina

,

Matthew E. Nielsen

³Department of Urology, University of North Carolina, Chapel Hill, North Carolina

,

Alison M. Stuebe

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina

⁴Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

› Author Affiliations

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

Full Text

References

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