Predictors of Receiving an Opioid Prescription Refill After Vaginal Delivery [25R]

Abstract

INTRODUCTION: Opioids are not routinely prescribed at our institution for postpartum care after vaginal deliveries (VD). We sought to determine a model to predict need for opioid prescription refill after a VD. METHODS: This is an IRB-approved secondary analysis retrospective cohort study of all VD at a single tertiary care center from Dec 2014 to May 2015 and Dec 2015 to May 2016. Medical records were queried for demographic and clinical data. Multivariable logistic regression modeling was performed to determine the most relevant predictors for receiving an opioid prescription refill within 30 days of discharge. The performance of the prediction model was assessed by using the Akaike information criterion (AIC). RESULTS: Of the total 1100 VD patients included, 24 (2.2%) received an opioid prescription refill within 30 days of discharge. Factors included in the top model according to AIC were last pain score (OR 1.267, CI 1.01-1.60, P=.045) and age (OR 1.10, CI 1.00-1.21, P=.044). Predictors that were not included in the top model according to AIC were BMI, race, postpartum tubal ligation, gravidity, gestational age, tobacco use, psychiatric diagnoses and insurance. CONCLUSION: Last pain score is a significant modifiable predictor for patients requiring a refill for opioid pain medications after a VD. Better control of pain prior to discharge may help decrease the need for opioid refills within 30 days of discharge after a VD.