Prescriber Opioid Patterns Following Cesarean Section Pre and Post
Intervention at a Large Academic Institution: a retrospective cohort
study.
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.