(P-537) Temporal and Hospital-level Variation in High-dose Postpartum Opioid Prescribing After Cesarean Delivery

Background: In the past decade, there has been a growing effort to prescribe opioids more judiciously to patients after surgical procedures, including among women after cesarean delivery. Though several studies have focused on examining patients’ characteristics that are associated with the prescribing of opioids after delivery, it is also important to understand the role of institutional prescribing preferences.

Objectives: We sought to describe the temporal and hospital-level variation in high dose postpartum opioid prescribing among women after cesarean delivery.

Methods: We identified opioid naïve women enrolled in Tennessee Medicaid with a cesarean delivery and restricted the analysis to deliveries occurring at Tennessee hospitals with >50 deliveries during the study period (2007-2014). Pharmacy prescription fill data were used to characterize the prescribed daily dose of the initial postpartum opioid filled in the first 4 days after delivery (morphine milligram equivalents [MME]). We examined the overall and yearly proportion of cesarean deliveries with a high dose postpartum opioid fill (>50 MME/day) for each hospital.

Results: We observed 65,703 cesarean deliveries among 71 unique hospitals during the study period (range: 80-5,615 deliveries per hospital). The proportion of women receiving high dose postpartum opioids was highest in 2007 (45.3%) and lowest during 2014 (29.8%). At the hospital level, 77.5% of facilities had lower high dose opioid prescribing in 2014 versus 2007 [median change: 15.3% reduction; range: 60.1% reduction to 70.3% increase]. Across hospitals, the median and maximum proportion of women with high dose prescribing were lower in 2014 (median: 20.6%; maximum: 73.4%) compared to 2007 (median: 39.3%; maximum: 89.0%). Of the 15 hospitals in the upper quintile of high dose opioid prescribing in 2007, nearly half (n=7) remained in the upper quintile in 2014.

Conclusions: The proportion of women filling a high dose postpartum opioid prescription after cesarean delivery declined during the study period. However, the changes in high dose opioid prescribing varied substantially over time across hospitals. Even as high dose prescribing after cesarean declines overall, our findings underscore the combined relevance of institutional prescribing preferences and patient characteristics on the prescribing of opioids after cesarean. These findings should inform initiatives to improve opioid prescribing at the facility level.