Patient and Health Care Provider Factors Associated With Prescription of Opioids After Delivery.

OBJECTIVE To identify patient and health care provider characteristics associated with receipt of a high amount of prescribed opioids at postpartum discharge. METHODS This was a retrospective case-control study of all opioid-naïve women delivering at a single, high-volume tertiary care center between December 1, 2015, and November 30, 2016. Inpatient, outpatient, pharmacy, and billing records were queried for clinical, prescription, and health care provider (training, age, gender) data. The discharging health care provider, whether an opioid prescription was provided, and the details of any opioid prescription were determined. A high amount of prescribed opioids was defined as morphine milligram equivalents greater than the 90th percentile (determined as 300 morphine milligram equivalents for vaginal and 500 morphine milligram equivalents for cesarean delivery). Multivariable logistic regression models with random effects were used to identify patient and health care provider factors independently associated with receipt of a high amount of prescribed opioids at discharge. Findings were analyzed separately by mode of delivery. RESULTS The analysis included 12,362 women. High amounts of opioids were prescribed for 636 of 9,038 (7.0%) women who delivered vaginally and 241 of 3,288 (7.3%) of those delivering by cesarean. In multivariable analysis, patient factors associated with receipt of a high amount of prescribed opioids at discharge after a vaginal delivery included nulliparity, intrapartum neuraxial anesthesia, major laceration, and infectious complication. Discharge by a trainee physician was associated with decreased odds of receiving a high amount of opioids (8.5% vs 1.9%; adjusted odds ratio [OR] 0.08, 95% CI 0.01-0.53). For women who underwent cesarean delivery, the only patient factor associated with receipt of a high amount of prescribed opioids was hemorrhage. Discharge by a trainee physician was associated with decreased odds of being provided a high-amount opioid prescription (7.9% vs 0.4%; adjusted OR 0.01, 95% CI 0.00-0.36). CONCLUSION Even after adjusting for patient factors, discharge by a trainee physician is significantly associated with decreased odds of a high amount of prescribed opioids at postpartum discharge.

[1]  David K. Wyant,et al.  Compositional and contextual factors associated with drug overdose deaths in the United States , 2020, Journal of addictive diseases.

[2]  W. Grobman,et al.  Opioid prescribing patterns among postpartum women , 2018, American journal of obstetrics and gynecology.

[3]  L. Davidson,et al.  Patient, Provider, and Practice Characteristics Associated with Inappropriate Antimicrobial Prescribing in Ambulatory Practices , 2018, Infection Control & Hospital Epidemiology.

[4]  C. Brummett,et al.  Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter? , 2017, Annals of surgery.

[5]  Randall Young,et al.  Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015 , 2017, MMWR. Morbidity and mortality weekly report.

[6]  L. Zuckerwise,et al.  Opioid Epidemic : Original Research Postdischarge Opioid Use After Cesarean Delivery , 2022 .

[7]  K. Huybrechts,et al.  Patterns of Opioid Prescription and Use After Cesarean Delivery. , 2017, Obstetrics and gynecology.

[8]  C. Brummett,et al.  Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey , 2017, JAMA.

[9]  D. Scharfstein,et al.  Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation With Subsequent Postclosure Deep Wound Infection (Bioburden Study). , 2017, Journal of orthopaedic trauma.

[10]  R. Barth,et al.  Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures , 2017, Annals of surgery.

[11]  H. Hedegaard,et al.  Drug Overdose Deaths in the United States, 1999-2015. , 2017, NCHS data brief.

[12]  P. Karaca-Mandic,et al.  Hospital Prescribing of Opioids to Medicare Beneficiaries. , 2016, JAMA internal medicine.

[13]  T. Haegerich,et al.  Using the CDC Guideline and Tools for Opioid Prescribing in Patients with Chronic Pain. , 2016, American family physician.

[14]  Roger Chou,et al.  CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. , 2016, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[15]  Janet Woodcock,et al.  A Proactive Response to Prescription Opioid Abuse. , 2016, The New England journal of medicine.

[16]  I. Binswanger,et al.  Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery , 2016, PloS one.

[17]  Hannah Harrison,et al.  Predictors of Higher-Risk Chronic Opioid Prescriptions in An Academic Primary Care Setting , 2016, Substance abuse.

[18]  M. Rice,et al.  Frequency of and Factors Associated With Severe Maternal Morbidity , 2014, Obstetrics and gynecology.

[19]  Laxmaiah Manchikanti,et al.  Opioid epidemic in the United States. , 2012, Pain physician.

[20]  J. Bishoff,et al.  Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. , 2011, The Journal of urology.

[21]  Leonard J. Paulozzi,et al.  Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008. , 2011, MMWR. Morbidity and mortality weekly report.

[22]  R. Dittus,et al.  Differences in antibiotic prescribing among physicians, residents, and nonphysician clinicians. , 2005, The American journal of medicine.