Persistent opioid use after cesarean delivery in the United States of America: a systematic review

Background: This systematic review assessed the incidence of persistent opioid use after cesarean delivery in opioid-naive individuals in the United States of America (USA).Methods: A literature search identified articles that reported persistent opioid use after cesarean delivery between January 2000 and February 2022. Studies were manually reviewed, and data pertaining to rates of persistent postpartum opioid use and methodologic information were qualitatively analyzed. Sixty studies were identified, and four met inclusion criteria. All four studies were retrospective reviews of insurance claims data among individuals naive to opioids. Data from 486 263 individuals delivering between 2001 and 2016 were included. The criteria to define persistent opioid use in opioid-naive individuals generally involved two or more opioid prescriptions filled within the first year after cesarean delivery, with each definition including additional varying criteria.Results: Rates of persistent opioid use after cesarean delivery ranged from 0.12% to 2.2%, with the highest rate reported in private insurance claims between 2008 and 2016. Findings suggest a substantial number of individuals are at risk (from 1:1000 to 1:50) for persistent opioid use up to 12 months postpartum. With 1.2 million individuals undergoing cesarean delivery annually in the USA, as few as 1440 and as many as 26 400 may continue using opioids past the fourth trimester.Conclusions: Findings emphasize the importance of developing a standardized definition of persistent opioid use to accurately assess the risk, rate, and trends for persistent opioid use among opioid-naive individuals undergoing cesarean delivery.