OBJECTIVE: This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. STUDY DESIGN: We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge. RESULTS: Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90-195] PRE to 114 [range: 45-168] POST (p = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5-8] vs. POST 5 [range: 3-7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16-30] vs. POST 17.5 [range: 4-25], p = 0.001). The number of pills consumed was significantly associated with number prescribed (p < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2-6] vs. POST 3[range: 1-5], p = 0.03). CONCLUSION: Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients. KEY POINTS: · An ERAS-CD pathway was associated with decreased opioid use.. · Outpatient opioid consumption after cesarean warrants further study.. · Physician prescribing drives patients' opioid consumption.. Thieme. All rights reserved.
OBJECTIVE: This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. STUDY DESIGN: We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge. RESULTS: Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90-195] PRE to 114 [range: 45-168] POST (p = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5-8] vs. POST 5 [range: 3-7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16-30] vs. POST 17.5 [range: 4-25], p = 0.001). The number of pills consumed was significantly associated with number prescribed (p < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2-6] vs. POST 3[range: 1-5], p = 0.03). CONCLUSION: Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients. KEY POINTS: · An ERAS-CD pathway was associated with decreased opioid use.. · Outpatient opioid consumption after cesarean warrants further study.. · Physician prescribing drives patients' opioid consumption.. Thieme. All rights reserved.
Authors: Gregg Nelson; Jamie Bakkum-Gamez; Eleftheria Kalogera; Gretchen Glaser; Alon Altman; Larissa A Meyer; Jolyn S Taylor; Maria Iniesta; Javier Lasala; Gabriel Mena; Michael Scott; Chelsia Gillis; Kevin Elias; Lena Wijk; Jeffrey Huang; Jonas Nygren; Olle Ljungqvist; Pedro T Ramirez; Sean C Dowdy Journal: Int J Gynecol Cancer Date: 2019-03-15 Impact factor: 3.437
Authors: R Douglas Wilson; Aaron B Caughey; Stephen L Wood; George A Macones; Ian J Wrench; Jeffrey Huang; Mikael Norman; Karin Pettersson; William J Fawcett; Medhat M Shalabi; Amy Metcalfe; Leah Gramlich; Gregg Nelson Journal: Am J Obstet Gynecol Date: 2018-09-18 Impact factor: 8.661
Authors: Brian T Bateman; Naida M Cole; Ayumi Maeda; Sara M Burns; Timothy T Houle; Krista F Huybrechts; Caitlin R Clancy; Stephanie B Hopp; Jeffrey L Ecker; Holly Ende; Kasey Grewe; Beatriz Raposo Corradini; Robert E Schoenfeld; Keerthana Sankar; Lori J Day; Lynnette Harris; Jessica L Booth; Pamela Flood; Melissa E Bauer; Lawrence C Tsen; Ruth Landau; Lisa R Leffert Journal: Obstet Gynecol Date: 2017-07 Impact factor: 7.661
Authors: Aaron B Caughey; Stephen L Wood; George A Macones; Ian J Wrench; Jeffrey Huang; Mikael Norman; Karin Pettersson; William J Fawcett; Medhat M Shalabi; Amy Metcalfe; Leah Gramlich; Gregg Nelson; R Douglas Wilson Journal: Am J Obstet Gynecol Date: 2018-08-15 Impact factor: 8.661
Authors: Brian T Bateman; Jessica M Franklin; Katsiaryna Bykov; Jerry Avorn; William H Shrank; Troyen A Brennan; Joan E Landon; James P Rathmell; Krista F Huybrechts; Michael A Fischer; Niteesh K Choudhry Journal: Am J Obstet Gynecol Date: 2016-03-17 Impact factor: 8.661
Authors: Larissa A Meyer; Javier Lasala; Maria D Iniesta; Alpa M Nick; Mark F Munsell; Qiuling Shi; Xin Shelley Wang; Katherine E Cain; Karen H Lu; Pedro T Ramirez Journal: Obstet Gynecol Date: 2018-08 Impact factor: 7.661
Authors: Luciana Mullman; Patrick Hilden; Jan Goral; Nnamdi Gwacham; Caitlin Tauro; Kristen Spinola; Kim Rosales; Sheila Collier; Lynice Holmes; Janice Maccione; Richard Pitera; Richard Miller; Paul Yodice Journal: Obstet Gynecol Date: 2020-10 Impact factor: 7.623