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• W2905859788 abstract "Opioid use is common for the management of postpartum pain. We sought to evaluate patient factors associated with time to first opioid dose following delivery. Retrospective case control study of all women who underwent delivery at a large tertiary care center (12/2015-16). Women were excluded if they had a nonsteroidal anti-inflammatory drug (NSAID) or morphine allergy. Inpatient records were queried for mode of delivery, patient characteristics, time-to-first opioid dose, and time-to-first NSAID dose after delivery. Time-to-first opioid was compared by patient characteristics with bivariable Cox regressions; these characteristics included age, BMI, self-described race/ethnicity, insurance, nulliparity, marital status, and history of anxiety, depression, smoking, and substance use. Factors which were significantly associated with time-to-use (p ≤ 0.05) on bivariable analysis were included in multivariable Cox regression models to identify factors independently associated with time-to-first opioid dose. Women who underwent vaginal delivery (VD) and cesarean delivery (CD) were analyzed separately. A total of 7,962 women who underwent VD and 2,831 women who underwent CD were included. In the final regression model for women who underwent VD, greater time-to-first NSAID dose (aHR 1.34, 95% CI 1.18-1.51), greater BMI (aHR 1.02, 95% CI 1.02-1.03), nulliparity (aHR 1.10, 95% CI 1.02-1.19), and a history of smoking (aHR 1.24, 95% CI 1.10-1.40) were significantly associated with earlier time-to-first opioid dose (Table). In the final regression model for women undergoing CD, only history of smoking (aHR 1.19, 95% CI 1.05-1.35) and depression (aHR 1.15, 95% CI 1.02-1.30) were significantly associated with earlier time-to-first opioid dose (Figure). Conversely, nulliparity (aHR 0.85, 95% CI 0.79-0.92) and Asian race (aHR 0.84, 95% CI 0.72-0.98) were associated with a significantly greater time-to-first opioid dose for women who had CD. The time-to-first opioid dose following delivery is associated with patient characteristics. Notably, in women who underwent VD, a later first NSAID dose was significantly associated with a decreased time-to-first opioid dose. This finding suggests the potential importance of considering multimodal pain management strategies in postpartum women as a means of delaying opioid exposure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
• W2905859788 created "2019-01-01" @default.
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• W2905859788 date "2019-01-01" @default.
• W2905859788 modified "2023-09-23" @default.
• W2905859788 title "353: Patient factors associated with time to first opioid dose following delivery" @default.
• W2905859788 doi "https://doi.org/10.1016/j.ajog.2018.11.374" @default.
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