Department of Family Medicine, La Crosse, WI.
Department of Obstetrics and Gynecology, Gundersen Health System, La Crosse, WI.
Am J Obstet Gynecol MFM. 2019 Nov;1(4):100055. doi: 10.1016/j.ajogmf.2019.100055. Epub 2019 Oct 10.
The postpartum period can be a particularly vulnerable time for exposure to opioid medications, and there are currently no consensus guidelines for physicians to follow regarding opioid prescribing during this period.
The purpose of this study was to evaluate inter- and intrahospital variability in opioid prescribing patterns in postpartum women and better understand the role of clinical variables in prescribing.
Data were extracted from electronic medical records on 4248 patients who delivered at 6 hospitals across the United States from January 2016 through March 2016. The primary outcome of the study was postpartum opioid prescription at the time of hospital discharge. Age, parity, route of delivery, and hospital were analyzed individually and with multivariate analyses to minimize confounding factors. Statistical methods included χ to analyze frequency of opioid prescription by hospital, parity, tobacco use, delivery method, and laceration type. An analysis of variance was used to analyze morphine equivalent dose by hospital.
The percentage of women prescribed postpartum opioids varied significantly by hospital, ranging from 27.6% to 70.9% (P <0.001). Oxycodone-acetaminophen was the most commonly prescribed medication (50.3%) with each hospital having its preferred opioid type. Median number of tablets prescribed ranged from 20 to 40 (P < .0001). Primiparous women were more likely to receive opioids than multiparous women when broken down by a parity of 1, 2, 3, 4, and ≥5 (52.8%, 48.0%, 47.6%, 40.1%, and 45.8%, respectively, P = .0005). Among women who had vaginal deliveries, opioid prescription rates were higher in women who experienced either a second-degree laceration (35.5%, P = .0002) or a third-/fourth-degree laceration (59.3%, P < .001).
Postpartum opioid prescription rates vary widely among hospitals, but providers within the same hospital tend to follow similar prescribing trends. The variation in prescribing found in our study illustrates the need for clear consensus guidelines for postpartum pain management.
产后阶段是接触阿片类药物的特别脆弱时期，目前对于医生在该阶段开具阿片类药物处方，并没有共识指南。
本研究旨在评估产后妇女的阿片类药物处方模式在医院间和医院内的差异，并更好地了解临床变量在处方中的作用。
从 2016 年 1 月至 2016 年 3 月在美国 6 家医院分娩的 4248 名患者的电子病历中提取数据。本研究的主要结局是患者在出院时开具的产后阿片类药物处方。年龄、产次、分娩方式和医院单独进行分析，并进行多变量分析以尽量减少混杂因素。统计方法包括 χ²检验分析医院、产次、吸烟状况、分娩方式和裂伤类型对阿片类药物处方的影响。方差分析用于分析医院间吗啡等效剂量的差异。
开具产后阿片类药物的女性比例在医院间差异显著，范围为 27.6%至 70.9%（P <0.001）。羟考酮-对乙酰氨基酚是最常用的药物（50.3%），每家医院都有其首选的阿片类药物类型。处方的片剂数中位数范围为 20 至 40 片（P <0.0001）。按产次 1、2、3、4 和≥5 分组时，初产妇比多产妇更有可能接受阿片类药物（分别为 52.8%、48.0%、47.6%、40.1%和 45.8%，P=0.0005）。在经历了二度裂伤（35.5%，P=0.0002）或三度/四度裂伤（59.3%，P<0.001）的阴道分娩女性中，阿片类药物处方率更高。
医院间产后阿片类药物处方率差异很大，但同一医院内的医生往往遵循相似的处方趋势。本研究中发现的处方差异表明，需要制定明确的产后疼痛管理共识指南。
