Poster Session 3
Category: Obstetric Quality and Safety
Poster Session 3
Sarah W. Freeman, MD (she/her/hers)
Resident Physician
Tufts Medical Center
Boston, Massachusetts, United States
Mohak Mhatre, MD (she/her/hers)
MFM Fellowship Director, Associate Professor
Tufts University School of Medicine
Boston, Massachusetts, United States
Megan J. Li, MD
Resident Physician
Tufts University School of Medicine
Boston, Massachusetts, United States
Meghan E. Beard, MD
Resident Physician
George Washington School of Medicine
Washington, District of Columbia, United States
Leanne Ludwick, MD
Resident Physician
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Massachusetts, United States
Devika Lekshmi, MPH (she/her/hers)
Statistician
Tufts University School of Medicine
Boston, Massachusetts, United States
Sebastian Z. Ramos, MD (he/him/his)
Assistant Professor
Tufts University School of Medicine
Boston, Massachusetts, United States
To evaluate the theoretical impact of three individualized prescribing protocols (based on inpatient opioid consumption) on post-cesarean discharge prescriptions compared to actual prescribing patterns.
Study Design:
This retrospective cohort study included all patients 18 and older who underwent cesarean delivery from September 1st, 2023 to December 31st, 2023 at a single academic center. Inpatient opioid use was abstracted from electronic medical records and used to calculate discharge prescriptions based on three previously published protocols: Bleicher et al. (2022), Osmundson et al. (2018), and Smid et al. (2024). These modeled prescriptions were compared to the actual prescriptions received at discharge. Outcomes included total dose prescribed in morphine milligram equivalents (MME) and number of pills prescribed.
Results:
A total of 208 patients were included who underwent primary (n=131, 63%) or repeat cesarean deliveries (n=77, 37%). Of these, 197 (95%) received an opioid prescription at discharge, and had a median total dose of 75 MME. Both median total dose and number of pills prescribed at discharge were reduced by >70% using the Bleicher or Smid models (Table 1, Figure 1). Compared to actual prescribing, both Bleicher and Smid models reduced the number of prescriptions sent by 37%, while the Osmundson model resulted in a 5% increase in the number of prescriptions issued.
Conclusion:
Individualized prescribing protocols based on inpatient opioid use after cesarean delivery substantially reduced the total number of prescriptions and opioid dosages sent on discharge, though effectiveness varied by model. Considering inpatient opioid use to inform discharge prescription quantity may enhance opioid stewardship and reduce excess prescribing. Future studies should incorporate patient-reported outcomes, including satisfaction with pain control, to ensure that reduced prescribing does not compromise adequate postoperative analgesia.