Demographics
Our study included 1,494 patients who received a Cesarean Section at
Montefiore Medical Center Weiler Campus between July 1, 2016 to December
31, 2016 and January 1, 2018 to August 31, 2018 and were discharged from
the hospital. Of these patients, 739 had their cesarean between July 1,
2016 through December 31, 2016, before the mandated NYDOH opioid
training (the “pre-intervention” group), and 755 had their cesarean
between January 1, 2018 through August 31, 2018, after the mandated
opioid training (the “post-intervention” group). The patient
demographic and obstetric characteristics were similar between groups
(Table 1a). The majority of patients were less than 35 years old,
Hispanic, English-speaking and nulliparous. Most patients were
overweight or obese (BMI >25; 77.8%). In addition, more
than half of the patients in each group did not have any prior cesarean
sections (51.3%)
The patients’ hospital and surgical characteristics were similar between
groups. Table 1b shows the relevant details about each cesarean section
and hospital course stratified by whether the patients underwent the
surgery before or after the mandated opioid training. The majority of
patients in both groups had unscheduled cesarean sections
(pre-intervention: 67.3%, post-intervention: 62.8%). The most common
indication for cesarean section was repeat procedure followed by fetal
intolerance, and labor dystocia. In majority of the cases the estimated
blood loss was less than 1000cc. However, there was a statistical
significance between cohorts with 71% of cases pre-intervention
reporting a blood loss less than 1000cc versus 60.7% post-intervention
(p = 0.001). In most cases sutures were used for skin closure, but the
percentage of surgeries utilizing staples significantly decreased from
9.3% pre-intervention to 5.4% post-intervention (p-value = 0.009).
Surgical time varied significantly as well. The majority of cases in the
pre-intervention group lasted between 30 to 60 minutes versus between 60
to 90 minutes in the post-intervention group (p-value =0.005). For both
groups, the most common length of stay in the hospital was 2-3 days.
Many of the patients in both groups had horizontal skin incisions (97%)
and neuraxial anesthesia (97-98%). Most had no other procedures
performed at the time of cesarean (86-88%), or in-hospital infections
(89-90%). Finally, there was a statistically significant association
between the level of provider prescribing the narcotics and cohort (pre
vs post intervention) (p-value = 0.001). However, within both the pre
and post intervention groups, the largest percentage of narcotic
prescribers were first year residents (pre-intervention: 66.2%,
post-intervention: 72.5%).