Examining Age and Postoperative Opioid Use in the Urogynecology Population: A Prospective Study

Abstract

Importance Surgeons must individualize postoperative pain management while also reducing the amount of unused prescribed opioids. Objectives This study compared postoperative opioid use in younger versus older women following urogynecologic surgery. We also assessed the likelihood of women returning unused opioids for safe disposal. Study Design This was a prospective study of women undergoing pelvic reconstructive surgery divided into 2 cohorts: younger (<65 years) and older (≥65 years). Our primary outcome was total opioid use, measured in morphine milligram equivalents (MME). We also assessed the average pain score during the first week after surgery measured by a numerical pain scale (range, 0–10). Our secondary outcome was the rate of return of unused prescribed opioids at the 6-week postoperative visit utilizing a disposable drug deactivation system. Results From April 2019 to September 2021, 152 participants were enrolled: 92 (61%) in the younger cohort (mean age, 51 ± 8 years) and 60 (39%) in the older cohort (mean age, 72 ± 6 years). For our primary outcome, younger women used significantly more opioids during the first postoperative week compared with older women (49 ± 71 vs 28 ± 40 MME, respectively, P = 0.04), despite no difference in average pain scores (4 ± 2 younger vs 3 ± 2 older, P = 0.05). For our secondary outcome, 23% of participants returned their opioids for disposal with the drug deactivation system. Conclusions Younger women had higher postoperative opioid use despite similar pain scores after urogynecologic surgery. Among those prescribed opioids, a quarter of participants returned their opioids for disposal at their postoperative visit.

Age and postoperative opioid use in women undergoing pelvic organ prolapse surgery

“…Prior studies have suggested an association between younger age and increased pain or opioid following pelvic reconstructive surgery, specifically in a POP population. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Notably, many of these studies dichotomized age at different and arbitrary cut‐points, resulting in a loss of statistical efficiency and inability to characterize opioid use fully across the spectrum of patient ages (such as exploring for the presence of a parabola or plateau effect). 12 , 13 , 14 , 15 , 16 , 17 , 19 , 24 For example, Willis‐Gray (2019) analyzed 183 US patients who underwent POP or stress incontinence surgery and reported that women aged 65 and younger were more likely to be given opioids and received higher amounts of opioids while in post‐anesthesia care than were women older than 65 years, after controlling for surgical factors, depression and body mass index.…”

“… 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Notably, many of these studies dichotomized age at different and arbitrary cut‐points, resulting in a loss of statistical efficiency and inability to characterize opioid use fully across the spectrum of patient ages (such as exploring for the presence of a parabola or plateau effect). 12 , 13 , 14 , 15 , 16 , 17 , 19 , 24 For example, Willis‐Gray (2019) analyzed 183 US patients who underwent POP or stress incontinence surgery and reported that women aged 65 and younger were more likely to be given opioids and received higher amounts of opioids while in post‐anesthesia care than were women older than 65 years, after controlling for surgical factors, depression and body mass index. Additionally, potential confounding due to preoperative pain and patient factors, such as mental health, known to be related to patient age and associated with postoperative pain and opioid use, has been incompletely accounted for to date.…”

“… 10 , 11 Although it has been suggested that young age is a predictor of postoperative pain and opioid use more broadly, studies attempting to verify this risk factor in a POP patient population have unnecessarily dichotomized age, not reported the actual range of ages represented in the sample, and incompletely accounted for the potential confounding role of preoperative pelvic pain and mental health. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 …”