Department of Obstetrics and Gynecology, Washington University in St. Louis, 4901 Forest Park Ave, St. Louis, MO, 63108, USA.
Woman and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA.
BMC Pregnancy Childbirth. 2021 Jun 22;21(1):434. doi: 10.1186/s12884-021-03954-8.
To identify the association between inpatient postpartum opioid consumption, race, and amount of opioids prescribed at discharge after vaginal or cesarean delivery.
A total of 416 women who were prescribed an oral opioid following vaginal or cesarean delivery at a single tertiary academic institution between July 2018 and October 2018 were identified. Women with postoperative wound complications, third and fourth degree lacerations, cesarean hysterectomy, or a history of opioid abuse were excluded. The primary outcome was the number of oxycodone 5 mg tablets prescribed at discharge, stratified by race and mode of delivery. Only "Black" and "White" women were included in analyses due to low absolute numbers of other identities. Black women were compared to white women using multivariable logistic regression. Multiple sensitivity analyses were performed.
The median number of oxycodone tablets consumed during hospitalization following cesarean delivery was seven (IQR: 2.5-12 tablets) and following vaginal delivery was one (IQR: 0-3). White women were more likely to be older at delivery regardless of route (median 32 vs. 30 years for cesarean delivery, and 29 vs. 27 years for vaginal delivery; p < 0.01 for both). White women undergoing cesarean delivery did so at a lower maternal BMI (31.6 vs. 34.5; p = 0.02). White women were also significantly more likely to have private insurance and to experience perineal lacerations following vaginal delivery. The number of inpatient opioid tablets consumed, as well as the number prescribed at discharge, were not statistically different between Black and White women, regardless of mode of delivery. These findings persisted in sensitivity analyses.
At our large, academic hospital the number of tablets prescribed at discharge had no association with patient race or inpatient usage regardless of mode of delivery.
确定阴道分娩或剖宫产分娩后住院期间阿片类药物的消耗、种族以及出院时开具的阿片类药物的数量之间的关联。
共确定了 2018 年 7 月至 2018 年 10 月期间在一家三级学术机构接受阴道或剖宫产术后开具口服阿片类药物的 416 名女性。排除术后伤口并发症、三度和四度裂伤、剖宫产子宫切除术或阿片类药物滥用史的女性。主要结局是按种族和分娩方式分层出院时开具的羟考酮 5mg 片剂数量。由于其他身份的绝对数量较低，仅将“黑人”和“白人”妇女纳入分析。使用多变量逻辑回归比较黑人妇女与白人妇女。进行了多次敏感性分析。
剖宫产分娩后住院期间消耗的羟考酮片剂中位数为 7 片（IQR：2.5-12 片），阴道分娩后为 1 片（IQR：0-3 片）。无论途径如何，白人女性在分娩时都更有可能年龄较大（剖宫产的中位数为 32 岁，阴道分娩的中位数为 29 岁；两者均<0.01）。行剖宫产的白人女性的 BMI 较低（31.6 比 34.5；p=0.02）。白人女性还更有可能拥有私人保险，并在阴道分娩后出现会阴裂伤。无论分娩方式如何，黑人女性和白人女性消耗的住院阿片类药物数量以及出院时开具的药物数量均无统计学差异。这些发现在敏感性分析中仍然存在。
在我们的大型学术医院中，无论分娩方式如何，出院时开具的片剂数量与患者种族或住院期间使用情况均无关联。
