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Prescriber Opioid Patterns Following Cesarean Section Pre and Post Intervention at a Large Academic Institution: a retrospective cohort study.
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  • Alexa Cohen,
  • Talitha Bruney,
  • Melissa Fazzari,
  • Gayatri Nangia
Alexa Cohen
Montefiore Hospital and Medical Center
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Talitha Bruney
Montefiore Hospital and Medical Center
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Melissa Fazzari
Albert Einstein School
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Gayatri Nangia
Albert Einstein School
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Abstract

Objective: To describe opioid prescribing patterns following cesarean section before and after the New York State Department of Health (NYSDOH) mandated the Opioid Prescriber Training Program. Design: This is a retrospective cohort study. Setting: A single hospital institution in New York City, United States. Sample: 1,494 women hospitalized for cesarean section between July 2016 and August 2018. Methods: Chart review of patient records. Main Outcome Measures: Primary outcome was total amount of narcotic prescribed before and after the Opioid Prescriber Training. Secondary outcomes included outpatient opioid prescription habits by provider level, as well as outpatient opioid prescription patterns related to the amount of inpatient narcotic use, and patient, surgical, and hospital-specific factors. Results: There was a significant difference in narcotics prescribed before and after the training. The median dose of narcotic prescribed pre and post intervention was 150 morphine milligram equivalents (MME) which is equal to 20 pills of 5 mg of oxycodone. Pre-training, 41.1% of prescriptions amounted to >150 MME, compared with 21.3% post-training (p-value for association < 0.001). Post-training, all provider levels had reduced narcotic prescriptions in the category of >150 MME. Neither inpatient opioid use, patient demographic, surgical nor hospital factors affected opioid prescriber patterns. Conclusion: This suggests the NYSDOH mandated opioid training course had an effect on opioid prescribing patterns with the greatest impact noted in residents. Funding: None. Keywords: discharge prescriptions, obstetric narcotics, opioid training, post-cesarean narcotics.