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Obstetric Quality and Safety

Poster Session 4

(919) Retrospective analysis of opioid prescribing following obstetric procedures in patients with and without opioid exposure

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Bryan L. Aaron, MS (he/him/his)

Medical Student
University of Michigan Medical School
Ann Arbor, MI, United States

Coauthor(s)

Dana Feldman, BS (she/her/hers)

University of Michigan
Ann Arbor, MI, United States
JW

Jennifer Waljee, MD, MPH, MS

University of Michigan
Ann Arbor, MI, United States
MB

Mark Bicket, MD, PhD

University of Michigan
Ann Arbor, MI, United States
MM

Michelle Moniz, MD, MSc

University of Michigan
Ann Arbor, MI, United States
VG

Vidhya Gunaseelan, MBA, MHA, MS

Clinical Information Analyst Staff Specialist
University of Michigan
Ann Arbor, MI, United States
Alex Peahl, MD, MSc

University of Michigan
Ann Arbor, MI, United States

Objective: To compare opioid prescribing practices following obstetric procedures in pregnancy across opioid-naive patients and patients diagnosed with opioid use disorder (OUD).

Study Design: We performed a retrospective cohort study using claims data from Truven Medicaid and Truven Marketscan for patients aged 18-55 who gave birth from 1/1/2016 to 12/31/2020. We included patients who underwent an obstetric procedure in pregnancy from 270 to 4 days prior to childbirth admission. We compared opioid-naive patients (i.e., patients with no opioid prescriptions or diagnoses of OUD in pregnancy) to patients with OUD (i.e., patients with a diagnosis of OUD or who received medication for OUD). Outcomes included receipt of an opioid and prescription size (standardized to 5 mg tabs of oxycodone). Descriptive statistics between patients’ insurance type and opioid exposure were used to summarize the data.

Results: Among all patients that underwent an obstetric or non-obstetric procedure, 16,028 of 20,782 patients (77.1%) underwent obstetric procedures in pregnancy (opioid naive: 15,858/20,521; OUD: 170/261). The most common obstetrical procedure was amniocentesis (opioid-naive: 44.4%, OUD: 53.5%), followed by transvaginal cerclage (opioid-naive: 39.3%, OUD: 38.2%), and chorionic villus sampling (CVS; opioid-naive: 15.9%, OUD: 7.6%). Across all procedures, the rate of opioid prescribing was higher for patients with OUD than for opioid-naive patients and higher for patients with public insurance versus private insurance. For example, following amniocentesis, rates of opioid prescribing for patients with OUD with public (32.4%) and commercial (23.5%) insurance were higher than for opioid-naive patients with public (1.0%) or commercial (0.2%) insurance.

Conclusion: Patients with OUD and public insurance were more likely to receive opioid prescriptions following obstetric procedures in pregnancy than opioid-naive and commercially insured patients. Future work is needed to define appropriate, tailored prescribing recommendations for these groups that balance opioid stewardship with the need for excellent pain management.