Development and Validation of a Model to Predict Postdischarge Opioid Use After Cesarean Birth

Sarah S. Osmundson, Alese Halvorson, Kristin N. Graves, Clara Wang, Stephen Bruehl, Carlos G. Grijalva, Dan France, Katherine Hartmann, Shilpa Mokshagundam, Frank E. Harrell

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

OBJECTIVE: To develop and validate a prediction model for postdischarge opioid use in patients undergoing cesarean birth. METHODS: We conducted a prospective cohort study of patients undergoing cesarean birth. Patients were enrolled postoperatively, and they completed pain and opioid use questionnaires 14 days after cesarean birth. Clinical data were abstracted from the electronic health record (EHR). Participants were prescribed 30 tablets of hydrocodone 5 mg-acetaminophen 325 mg at discharge and were queried about postdischarge opioid use. The primary outcome was total morphine milligram equivalents used. We constructed three proportional odds predictive models of postdischarge opioid use: a full model with 34 predictors available before hospital discharge, an EHR model that excluded questionnaire data, and a reduced model. The reduced model used forward selection to sequentially add predictors until 90% of the full model performance was achieved. Predictors were ranked a priori based on data from the literature and prior research. Predictive accuracy was estimated using discrimination (concordance index). RESULTS: Between 2019 and 2020, 459 participants were enrolled and 279 filled the standardized study prescription. Of the 398 with outcome measurements, participants used a median of eight tablets (interquartile range 1-18 tablets) after discharge, 23.5% used no opioids, and 23.0% used all opioids. Each of the models demonstrated high accuracy predicting postdischarge opioid use (concordance index range 0.74-0.76 for all models). We selected the reduced model as our final model given its similar model performance with the fewest number of predictors, all obtained from the EHR (inpatient opioid use, tobacco use, and depression or anxiety). CONCLUSION: A model with three predictors readily found in the EHR-inpatient opioid use, tobacco use, and depression or anxiety-accurately estimated postdischarge opioid use. This represents an opportunity for individualizing opioid prescriptions after cesarean birth.

Original languageEnglish
Pages (from-to)888-897
Number of pages10
JournalObstetrics and Gynecology
Volume139
Issue number5
DOIs
StatePublished - May 1 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s).

Funding

Sarah S. Osmundson was supported by K23DA047476 from the National Institute on Drug Abuse; Stephen Bruehl was supported by R01DA050334 from the National Institute on Drug Abuse. Carlos G. Grijalva was supported by grant R01AG043471 through the National Institute on Aging. Frank E. Har-rell was supported by CTSA award No. UL1 TR002243 from the National Center for Advancing Translational Sciences.

FundersFunder number
National Institute on Drug AbuseR01DA050334, R01AG043471
National Institute on Drug Abuse
National Institute on AgingUL1 TR002243
National Institute on Aging
National Center for Advancing Translational Sciences (NCATS)

    ASJC Scopus subject areas

    • Obstetrics and Gynecology

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