Post-operative Opioid Prescribing and Consumption after Hysterectomy: a Prospective Cohort Study



Abstract

Study Objective

To examine opioid prescribing and consumption patterns after hysterectomy and identify
factors associated with post-operative opioid consumption.

Design

Prospective cohort study.

Setting

Single university medical center.

Patients

Women undergoing hysterectomy for benign, non-obstetric indications.

Interventions

Participant pre-operative and surgical characteristics were obtained through chart
review and patient report of baseline pain score. During the third post-operative
week, participants completed a telephone interview, including direct count of remaining
opioid pills and assessment of satisfaction with pain management. We assessed factors
associated with opioid consumption in oral morphine equivalents using a linear regression
model.

Measurements and Main Results

Of the 129 participants, 113 (88%) completed the post-operative survey after hysterectomy:
16 vaginal, 43 robotic-assisted, 42 conventional laparoscopic, and 12 abdominal hysterectomies.
The median amount of opioid prescribed was 150 oral morphine equivalents (interquartile
range (IQR) 113-200), while the median amount consumed was 75 (IQR 10-135), reflecting
an average consumption of about 50% of the prescription. Opioid prescription size
was associated with consumption; for every additional one oral morphine equivalent
prescribed, on average, an additional 0.5 was consumed (
P<.001). If the indication for hysterectomy was related to pain, participants consumed
25.3 additional oral morphine equivalents (
P=.04). The amount of opioid prescribed was inversely correlated with pain management
satisfaction; every additional point on a 1 through 5 Likert scale of increasing satisfaction
was associated with 44 fewer OME prescribed (standard error 9 OME,
P<.001). For the 1,464 total unused pills among the 104 participants with leftover
opioids, only 20% reported an FDA-compliant opioid disposal plan.

Conclusion

Gynecologic surgeons can respond to the opioid epidemic by reducing excess opioid
pills after hysterectomy: providing both the smallest effective prescription size
as well as concrete resources for safe opioid disposal. These actions may contribute
to a reduction in opioid use disorder cases or overdose deaths.

Article Info

Publication History

Publication stage

In Press Journal Pre-Proof

Footnotes

Disclosure statement: Dr. Nejad was a speaker for Intuitive Surgical in 2018 and 2019. The remaining authors report no conflict of interest.

Funding: Financial support provided from the Department of Obstetrics and Gynecology, University of California Davis Health.

Role of funders: The funders did not have a role in study design, data collection, data analysis, decision to publish, or manuscript preparation.

Presentations: Society of Laparoendoscopic Surgeons’ 27th Annual Meeting, Minimally Invasive Surgery Week, September 4-7, 2019, New Orleans, Louisiana.

American Association of Gynecologic Laparoscopists, the 48th Global Congress on Minimally Invasive Gynecologic Surgery, November 9-13, 2019, Vancouver, British Columbia, Canada

Institutional Review Board ID: 1123925-4

Approval Date: 11/07/2017

The data that support the findings of this study are available upon request from the corresponding author.

Precis: Higher opioid consumption following hysterectomy was associated with larger prescriptions and pain-related indications for surgery; most women used half the prescribed amount and were unaware of safe opioid disposal practices.

Identification

DOI: https://doi.org/10.1016/j.jmig.2020.10.023

Copyright

© 2020 Published by Elsevier Inc. on behalf of AAGL.

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