The risk of serious opioid-related events associated with common opioid prescribing regimens in the postpartum period after cesarean delivery

Wiese, Andrew; Osmundson, Sarah S.; Mitchel, Edward F.; Adgent, Margaret A.; Phillips, Sharon; Patrick, Stephen W.; Spieker, Andrew J.; Grijalva, Carlos G

doi:10.1016/j.ajogmf.2021.100475

Cited by 12 publications

(8 citation statements)

References 30 publications

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“…For birthing individuals, this presents a barrier to independence and caring for a newborn, highlighting the importance of optimizing pain management following cesarean delivery. Experience with pain management interventions, such as enhanced recovery protocols following cesarean, suggests a significant role for thorough education through counseling and written instructions [ 17 ]. Additionally, a meta-analysis of emergency room discharge instructions suggested that correct recall may be highest among those who view video discharge instructions [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…The DISCERN instrument was used to assess the quality and reliability of the videos as an information source. This tool has been widely used to evaluate web-based sources of health information, including YouTube videos [16][17][18][19][20][21]. Studies have demonstrated that the DISCERN tool enables both professionals and consumers to distinguish between high-and low-quality sources of health information [19,22].…”

Section: Discern Analysismentioning

confidence: 99%

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Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis

Squires¹,

Soyemi²,

Yee³

et al. 2023

JMIR Infodemiology

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Background YouTube is an increasingly common source of health information; however, the reliability and quality of the information are inadequately understood. Several studies have evaluated YouTube as a resource during pregnancy and found the available information to be of poor quality. Given the increasing attention to postpartum health and the importance of promoting safe opioid use after birth, YouTube may be a source of information for birthing individuals. However, little is known about the available information on YouTube regarding postpartum pain. Objective The purpose of this study is to systematically evaluate the quality of YouTube videos as an educational resource for postpartum cesarean pain management. Methods A systematic search of YouTube videos was conducted on June 25, 2021, using 36 postpartum cesarean pain management–related keywords, which were identified by clinical experts. The search replicated a default YouTube search via a public account. The first 60 results from each keyword search were reviewed, and unique videos were analyzed. An overall content score was developed based on prior literature and expert opinion to evaluate the video’s relevance and comprehensiveness. The DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of video information. Videos with an overall content score of ≥5 and a DISCERN score of ≥39 were classified as high-quality health education resources. Descriptive analysis and intergroup comparisons by video source and quality were conducted. Results Of 73 unique videos, video sources included medical videos (n=36, 49%), followed by personal video blogs (vlogs; n=32, 44%), advertisements (n=3, 4%), and media (n=2, 3%). The average overall content score was 3.6 (SD 2.0) out of 9, and the average DISCERN score was 39.2 (SD 8.1) out of 75, indicating low comprehensiveness and fair information reliability, respectively. High-quality videos (n=22, 30%) most frequently addressed overall content regarding pain duration (22/22, 100%), pain types (20/22, 91%), return-to-activity instructions (19/22, 86%), and nonpharmacologic methods for pain control (19/22, 86%). There were differences in the overall content score (P=.02) by video source but not DISCERN score (P=.45). Personal vlogs had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 (SD 2.0). Longer video duration and a greater number of comments and likes were significantly correlated with the overall content score, whereas the number of video comments was inversely correlated with the DISCERN score. Conclusions Individuals seeking information from YouTube regarding postpartum cesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. Clinicians should counsel patients to exercise caution when using YouTube as a health information resource.

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Section: Discussionmentioning

confidence: 99%

Section: Discern Analysismentioning

confidence: 99%

Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis

Squires¹,

Soyemi²,

Yee³

et al. 2023

JMIR Infodemiology

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“…RESULTS: From September 2020 to March 2022, 18,990 individuals were screened and 5,521 were enrolled (n52,748 IOPP group, n52,773 fixed-quantity group). For the primary outcome, IOPP with shared decision making was not inferior to fixed quantity (59.5% vs 60.1%, risk difference 0.67%; 95% CI, 22.03% to 3.37%, noninferiority margin 25.0) and resulted in significantly fewer tablets received (median 14 [interquartile range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] vs 20, P,.001) through 90 days postpartum.…”

Section: Methodsmentioning

confidence: 99%

“…6,7 Moreover, 0.12-2.20% of individuals will exhibit persistent opioid use at 1 year after cesarean birth, 8,9 placing them at risk of opioid-related complications, including overdose. 10,11 In the United States, development of individual-and population-level interventions that reduce unused tablets are high priorities to address the opioid epidemic. 12 Recent single-center trials suggest that individualized opioid-prescription protocols (IOPP) 13 with a shared decision-making component 14 are patientcentered interventions that may successfully tailor postcesarean opioid discharge quantity.…”

Section: Methodsmentioning

confidence: 99%

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Optimizing Opioid Prescription Quantity After Cesarean Delivery

Smid,

Clifton,

Rood

et al. 2024

Obstetrics &Amp; Gynecology

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OBJECTIVE: To test whether an individualized opioid-prescription protocol (IOPP) with a shared decision-making component can be used without compromising postcesarean pain management. METHODS: In this multicenter randomized controlled noninferiority trial, we compared IOPP with shared decision making with a fixed quantity of opioid tablets at hospital discharge. We recruited at 31 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Study participants had uncomplicated cesarean births. Follow-up occurred through 12 weeks postdischarge. Individuals with complicated cesarean births or history of opioid use in the pregnancy were excluded. Participants were randomized 1:1 to IOPP with shared decision making or fixed quantity (20 tablets of 5 mg oxycodone). In the IOPP group, we calculated recommended tablet quantity based on opioid use in the 24 hours before discharge. After an educational module and shared decision making, participants selected a quantity of discharge tablets (up to 20). The primary outcome was moderate to severe pain (score 4 or higher [possible range 0–10]) on the BPI (Brief Pain Inventory) at 1 week after discharge. A total sample size of 5,500 participants was planned to assess whether IOPP with shared decision making was not inferior to the fixed quantity of 20 tablets. RESULTS: From September 2020 to March 2022, 18,990 individuals were screened and 5,521 were enrolled (n=2,748 IOPP group, n=2,773 fixed-quantity group). For the primary outcome, IOPP with shared decision making was not inferior to fixed quantity (59.5% vs 60.1%, risk difference 0.67%; 95% CI, −2.03% to 3.37%, noninferiority margin −5.0) and resulted in significantly fewer tablets received (median 14 [interquartile range 4–20] vs 20, P<.001) through 90 days postpartum. CONCLUSION: Compared with fixed quantity, IOPP with shared decision making was noninferior for outpatient postcesarean analgesia at 1 week postdischarge and resulted in fewer prescribed opioid tablets at discharge. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04296396.

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Changes in Postpartum Opioid Prescribing After Implementation of State Opioid Prescribing Limits

Fry,

Jeffery,

Horta

et al. 2024

JAMA Health Forum

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ImportanceIn response to the growing opioid crisis, states implemented opioid prescribing limits to reduce exposure to opioid analgesics. Research in other clinical contexts has found that these limits are relatively ineffective at changing opioid analgesic prescribing.ObjectiveTo examine the association of state-level opioid prescribing limits with opioid prescribing within the 30-day postpartum period, as disaggregated by type of delivery (vaginal vs cesarean) and opioid naivete.Design, Setting, and ParticipantsThis retrospective, observational cohort study used commercial claims data from January 1, 2014, to December 31, 2021, from 49 US states and a difference-in-differences staggered adoption estimator to examine changes in postpartum opioid prescribing among all deliveries to enrollees between the ages of 18 and 44 years in the US.ExposuresThe implementation of a state opioid prescribing limit between 2017 and 2019.Main Outcomes and MeasurementsThe primary outcomes for this analysis were the number of prescriptions for opioid analgesics, proportion of prescriptions with a supply greater than 7 days, and milligrams of morphine equivalent (MMEs) per delivery between 3 days before and 30 days after delivery.ResultsA total of 1 572 338 deliveries (enrollee mean [SD] age, 30.20 [1.59] years) were identified between 2014 and 2021, with 32.3% coded as cesarean deliveries. A total of 98.4% of these were to opioid-naive patients. The mean MMEs per delivery was 310.79, with higher rates in earlier years, states that had an opioid prescribing limit, and cesarean deliveries. In a covariate-adjusted difference-in-differences regression analysis, opioid prescribing limits were associated with a decrease of 148.70 MMEs per delivery (95% CI, −657.97 to 360.57) compared with states without such limits. However, these changes were not statistically significant. The pattern of results was similar among other opioid-prescribing outcomes and types of deliveries.Conclusions and RelevanceThe results of this cohort study suggest that opioid prescribing limits are not associated with changes in postpartum opioid prescribing regardless of delivery type or opioid naivete, which is consistent with research findings on these limits in other conditions or settings. Future research could explore what kinds of prevention mechanisms reduce the risk of opioid prescribing during pregnancy and postpartum.

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The risk of serious opioid-related events associated with common opioid prescribing regimens in the postpartum period after cesarean delivery

Abstract: The risk of serious opioid-related events associated with common opioid prescribing regimens in the postpartum period after cesarean,

Cited by 12 publications

References 30 publications

Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis

Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis

Optimizing Opioid Prescription Quantity After Cesarean Delivery

Changes in Postpartum Opioid Prescribing After Implementation of State Opioid Prescribing Limits

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