Nora V Becker1, Karen J Gibbins2, Jeanmarie Perrone3, Brandon C Maughan4. 1. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, United States; Department of Health Care Management, Wharton School of Business, 204 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA, 19104-6218, United States; Department of Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States. Electronic address: nvbecker@partners.org. 2. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Utah Health, 50 N Medical Dr, Salt Lake City, UT, 84112, United States. Electronic address: karen.gibbins@hsc.utah.edu. 3. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, United States. Electronic address: jeanmarie.perrone@uphs.upenn.edu. 4. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, United States; Department of Health Care Management, Wharton School of Business, 204 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA, 19104-6218, United States; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, 13th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States; Department of Emergency Medicine, Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, 19104, United States. Electronic address: brandon.maughan@alumni.stanford.edu.
Abstract
BACKGROUND: Obstetric delivery is among the most common in-hospital procedures experienced by reproductive-age women, yet there is little literature on patterns of postpartum opioid prescriptions after such episodes. METHODS: We used claims data from 871,195 vaginal deliveries to 768,455 privately-insured women with an in-hospital delivery between June 2001 and July 2013 to examine the state- and census division-level proportions of women who filled an opioid prescription within four days of hospital discharge after vaginal delivery. Our primary outcome examined the proportion of women who filled an opioid prescription after uncomplicated vaginal delivery (e.g., without forceps extraction, vacuum extraction, or 3rd/4th degree perineal laceration). Secondary outcomes examined state- and census division-level variation in opioid prescription duration (proportion of prescriptions exceeding five days) and dose (proportion of prescriptions exceeding 280 morphine milligram equivalents). We also displayed national temporal trends in opioid prescribing rate and dose for uncomplicated vaginal delivery in comparison to complicated vaginal delivery. RESULTS: Across states, we found a 7-fold variation in postpartum opioid prescription rates (7.6-53.4%), a 5-fold variation in opioid prescriptions for greater than five days' duration (5.1-25.7%), and a 19% absolute difference in opioid prescriptions for greater than 280 morphine milligram equivalents (0-19.3%) following uncomplicated vaginal delivery. CONCLUSIONS: These wide variations in postpartum opioid prescription practices suggest opportunities to develop guidelines on postpartum opioid use, to improve prescription safety, and to reduce opioid-related harms among women in the postpartum period. Published by Elsevier B.V.
BACKGROUND: Obstetric delivery is among the most common in-hospital procedures experienced by reproductive-age women, yet there is little literature on patterns of postpartum opioid prescriptions after such episodes. METHODS: We used claims data from 871,195 vaginal deliveries to 768,455 privately-insured women with an in-hospital delivery between June 2001 and July 2013 to examine the state- and census division-level proportions of women who filled an opioid prescription within four days of hospital discharge after vaginal delivery. Our primary outcome examined the proportion of women who filled an opioid prescription after uncomplicated vaginal delivery (e.g., without forceps extraction, vacuum extraction, or 3rd/4th degree perineal laceration). Secondary outcomes examined state- and census division-level variation in opioid prescription duration (proportion of prescriptions exceeding five days) and dose (proportion of prescriptions exceeding 280 morphine milligram equivalents). We also displayed national temporal trends in opioid prescribing rate and dose for uncomplicated vaginal delivery in comparison to complicated vaginal delivery. RESULTS: Across states, we found a 7-fold variation in postpartum opioid prescription rates (7.6-53.4%), a 5-fold variation in opioid prescriptions for greater than five days' duration (5.1-25.7%), and a 19% absolute difference in opioid prescriptions for greater than 280 morphine milligram equivalents (0-19.3%) following uncomplicated vaginal delivery. CONCLUSIONS: These wide variations in postpartum opioid prescription practices suggest opportunities to develop guidelines on postpartum opioid use, to improve prescription safety, and to reduce opioid-related harms among women in the postpartum period. Published by Elsevier B.V.
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