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%).