Variations in Postpartum Opioid Prescribing Practices among Obstetrician-Gynecologists

Abstract

Introduction. Cesarean patients are commonly prescribed opioids when discharged from the hospital. This study aimed to determine if there were differences in prescribing practices based on the postoperative day opioid prescriptions were written, and before and after the publication of the American College of Obstetricians and Gynecologists (ACOG) Committee Opinion 742.

Methods. This retrospective chart review study included women who had a live birth via cesarean at a single institution from July 1, 2017, to February 28, 2021, and excluded patients with chorioamnionitis or discharged after more than 4 days. Opioids were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were grouped based on date of delivery in comparison to the publication of ACOG Committee Opinion 742 (July 2018). IRB approval was obtained for this study.

Results. Out of 411 patients, 93.9% (n=386) had opioids prescribed at discharge, 85.5% of whom (330/386) received a prescription written on the day of discharge. There was no difference in the quantity of MMEs in discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients delivering after the new ACOG Opinion (63.9%, n=263) received discharge prescriptions with fewer average MMEs (159.53±61.64) than those who delivered before the publication (36%, n=148) (187.35±53.42), c² (1, N=411) = 17.71, p < 0.001.

Conclusions. Patients delivering via cesarean after the published ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs. There was no difference between prescriptions written the day of versus before discharge.