Predictors of patient post-discharge opioid use after cesarean delivery: a prospective study

A. Cohen, X. Xie, R. Zeuner, S. Galperin, T. Bruney

Research output: Contribution to journalArticlepeer-review


Background: The opioid crisis is a public health emergency in the United States. It is important to understand factors associated with outpatient opioid use. Our primary aim was to assess post-cesarean outpatient opioid use. The secondary aim was to identify characteristics associated with use. Methods: We conducted a prospective cohort analysis of women who underwent cesarean delivery at an urban academic center. Phone surveys were done on post-discharge days three, seven, and 14. The primary outcome was post-discharge opioid use. Results: Of 205 eligible patients contacted, 190 (91%) agreed to participate and 173 (84%) participated in all three surveys. Median amount of opioid prescribed was 75 mg morphine equivalents (MME) (interquartile range 60–113) and participants used a median of 15 MME (0–53) by discharge day 14. Most patients (139/190) filled their opioid prescription but 42% (80/190) did not consume the opioids prescribed. Outpatient opioid use was associated with increased in-hospital opioid consumption (P=0.0003), gravidity (P=0.003), parity (P=0.004) and number of previous cesarean deliveries (P=0.02). Higher amounts of in-hospital opioid use (P=0.0004), higher gravidity (P=0.02), higher outpatient pain scores (>3/10, P=0.01), and poor pain control (P=0.04) were associated with consuming all prescribed opioids. Patients used opioids for a median of two days post-discharge. Use of non-opioid pain medication was not associated with opioid use. Conclusion: Opioids were prescribed in excess of consumption and many patients did not use any opioids. Next steps include developing a prescribing algorithm to incorporate factors we found predictive of opioid use.

Original languageEnglish (US)
Article number103249
JournalInternational Journal of Obstetric Anesthesia
StatePublished - May 2022


  • Cesarean delivery
  • Opioid prescriptions
  • Outpatient opioid use
  • Patient survey
  • Postoperative opioids

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Anesthesiology and Pain Medicine


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