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Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019
PURPOSE: To describe postdischarge opioid dispensing after Cesarean delivery (CD) in 49 hospitals in British Columbia (BC) and assess opportunities for opioid stewardship. METHODS: Using the BC Ministry of Health’s Hospital Discharge Abstract Database, we linked 135,725 CDs performed in 2004–2016 an...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9244301/ https://www.ncbi.nlm.nih.gov/pubmed/35764863 http://dx.doi.org/10.1007/s12630-022-02271-8 |
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author | Ziafat, Kimia Polderman, Stefanie Nabavi, Noushin Preston, Roanne Chau, Anthony Krausz, Michael R. Schwarz, Stephan K. W. Maclure, Malcolm |
author_facet | Ziafat, Kimia Polderman, Stefanie Nabavi, Noushin Preston, Roanne Chau, Anthony Krausz, Michael R. Schwarz, Stephan K. W. Maclure, Malcolm |
author_sort | Ziafat, Kimia |
collection | PubMed |
description | PURPOSE: To describe postdischarge opioid dispensing after Cesarean delivery (CD) in 49 hospitals in British Columbia (BC) and assess opportunities for opioid stewardship. METHODS: Using the BC Ministry of Health’s Hospital Discharge Abstract Database, we linked 135,725 CDs performed in 2004–2016 and 30,919 CDs performed in 2017–2019 (length of stay ≤ four days) by deidentified Personal Health Numbers to data on medications dispensed from all BC community pharmacies (PharmaNet). We excluded patients with cancer and those to whom opioids have been dispensed in the year before. We measured trends in annual percentages of patients dispensed opioids within seven days (opioid rate), with 95% confidence intervals (CIs), stratified by hospital and opioid type, adjusted for length of stay, and for autocorrelation within hospital using generalized linear modeling. RESULTS: The opioid dispensation rate dropped from 31% (95% CI, 30 to 33) in 2004 to 16% (95% CI, 15 to 17) in 2016, where it remained through 2019. Five hospitals showed steep reductions from over 40% to under 10% within two to three years, but in most hospitals the opioid dispensation rate decreased slowly—11 had little reduction and three showed increases. Codeine dispensing dropped from 31% in 2004–2008 by 4% per year, while tramadol and hydromorphone dispensing rose. After 2015, rates were stable (hydromorphone, 8%; tramadol, 6%; codeine, 3%; and oxycodone, 0.5%). CONCLUSION: After Health Canada’s 2008 warning against codeine use by breastfeeding mothers, post-CD opioid dispensing declined disjointedly across BC hospitals. Rates did not decrease further after the opioid overdose epidemic was declared a public health emergency in BC in 2016. The present study highlights opportunities for quality improvement and opioid stewardship through monitoring using administrative databases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12630-022-02271-8. |
format | Online Article Text |
id | pubmed-9244301 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-92443012022-06-30 Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019 Ziafat, Kimia Polderman, Stefanie Nabavi, Noushin Preston, Roanne Chau, Anthony Krausz, Michael R. Schwarz, Stephan K. W. Maclure, Malcolm Can J Anaesth Reports of Original Investigations PURPOSE: To describe postdischarge opioid dispensing after Cesarean delivery (CD) in 49 hospitals in British Columbia (BC) and assess opportunities for opioid stewardship. METHODS: Using the BC Ministry of Health’s Hospital Discharge Abstract Database, we linked 135,725 CDs performed in 2004–2016 and 30,919 CDs performed in 2017–2019 (length of stay ≤ four days) by deidentified Personal Health Numbers to data on medications dispensed from all BC community pharmacies (PharmaNet). We excluded patients with cancer and those to whom opioids have been dispensed in the year before. We measured trends in annual percentages of patients dispensed opioids within seven days (opioid rate), with 95% confidence intervals (CIs), stratified by hospital and opioid type, adjusted for length of stay, and for autocorrelation within hospital using generalized linear modeling. RESULTS: The opioid dispensation rate dropped from 31% (95% CI, 30 to 33) in 2004 to 16% (95% CI, 15 to 17) in 2016, where it remained through 2019. Five hospitals showed steep reductions from over 40% to under 10% within two to three years, but in most hospitals the opioid dispensation rate decreased slowly—11 had little reduction and three showed increases. Codeine dispensing dropped from 31% in 2004–2008 by 4% per year, while tramadol and hydromorphone dispensing rose. After 2015, rates were stable (hydromorphone, 8%; tramadol, 6%; codeine, 3%; and oxycodone, 0.5%). CONCLUSION: After Health Canada’s 2008 warning against codeine use by breastfeeding mothers, post-CD opioid dispensing declined disjointedly across BC hospitals. Rates did not decrease further after the opioid overdose epidemic was declared a public health emergency in BC in 2016. The present study highlights opportunities for quality improvement and opioid stewardship through monitoring using administrative databases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12630-022-02271-8. Springer International Publishing 2022-06-28 2022 /pmc/articles/PMC9244301/ /pubmed/35764863 http://dx.doi.org/10.1007/s12630-022-02271-8 Text en © Canadian Anesthesiologists' Society 2022 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Reports of Original Investigations Ziafat, Kimia Polderman, Stefanie Nabavi, Noushin Preston, Roanne Chau, Anthony Krausz, Michael R. Schwarz, Stephan K. W. Maclure, Malcolm Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019 |
title | Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019 |
title_full | Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019 |
title_fullStr | Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019 |
title_full_unstemmed | Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019 |
title_short | Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019 |
title_sort | opioid dispensing after cesarean delivery in british columbia: a historical cohort analysis from 2004 to 2019 |
topic | Reports of Original Investigations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9244301/ https://www.ncbi.nlm.nih.gov/pubmed/35764863 http://dx.doi.org/10.1007/s12630-022-02271-8 |
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