Development of a Postoperative Opioid Prescription Practice (POPP) Algorithm for Benign Gynecologic Surgery [05H]

Abstract

INTRODUCTION: Pain Management literature shows a strong correlation between days of initial opioid use and risk for chronic use. Opioid-prescribing practices vary widely within OB/GYN literature. The purpose of this study is to determine if gynecologic patients have satisfactory postoperative pain control using a novel Postoperative Opioid Prescription Practice (POPP) algorithm. METHODS: Patients undergoing benign gynecologic surgery at a large military treatment facility were recruited for this IRB-approved study. Patients completed a preoperative survey regarding baseline pain, substance use, chronic pain, depression or anxiety, and home pain management strategies. The quantity of opioids dispensed postoperatively was determined using the POPP algorithm. Patients completed a two-week postoperative survey assessing the number of remaining opioid tablets and their pain satisfaction. The current study group was compared to a retrospective cohort of patients treated for similar conditions. RESULTS: Final analysis included 68 patients from the 82 patients initially recruited. 97% of patients did not require an opioid refill and were satisfied with their postoperative pain control. 21% did not require any opioids following discharge. The POPP algorithm reduced opioid prescriptions from an average of 22.5 to 12.5 tablets. CONCLUSION: Use of the POPP algorithm resulted in a significantly decreased number of opioid tablets prescribed. The majority of patients were satisfied with their postoperative pain control and did not require refills of opioids despite less tablets prescribed. The POPP algorithm is a good starting point to guide gynecologic surgeons in postoperative opioid-prescribing practices. More data is needed to develop even stricter opioid prescription algorithms based on patient characteristics.