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INTRODUCTION: Few large studies have comprehensively evaluated which factors are associated with increased inpatient opioid analgesia after cesarean delivery. Our objective was to determine if specific maternal and peripartum risk factors are associated with high inpatient utilization of oxycodone after cesarean section. METHODS: IRB approved, retrospective case-control study of live singleton cesarean deliveries at 37 weeks of gestation or greater at a tertiary university hospital from 2013–2016. Patients were excluded for NSAID or opioid allergies, and incomplete medical records. Cases were patients with high oxycodone utilization (>90th percentile) and controls were those with normal oxycodone utilization (≤90th percentile). Patient demographics and clinical characteristics were examined to determine if they were associated with high oxycodone utilization. Statistical significance P<.05. RESULTS: A total of 7,415 deliveries were included. In this population, high utilization of oxycodone equated to greater than 42 mg/day (n=742). Maternal demographic factors associated with high utilization included advanced maternal age, Caucasian race, pre-pregnancy obesity, and multiparity. Peripartum factors associated with high utilization included prolonged postpartum hospitalization, repeat cesarean delivery, and increased birth weight. Among the social factors evaluated, smoking was associated with increased oxycodone use but prior drug use was not. Maternal comorbidities such as diabetes and hypertension, and pregnancy complications such as preeclampsia and obstetrical hemorrhage were not significantly associated with increased oxycodone use. CONCLUSION: After term cesarean deliveries, a number of maternal and peripartum factors are associated with increased inpatient oxycodone utilization. Our findings may help identify patient subgroups that necessitate interventions to prevent development of prolonged postoperative opioid use.

There is variation in CD rate relative to attending shift change, but the overall variation is small in magnitude. There are few clinically meaningful differences in obstetric interventions and outcomes based on proximity to shift change.