Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Chan, Wilson; Le, Britney; Lam, Melody; Shariff, Salimah Z.; Gomes, Tara; Lipscombe, Lorraine L.; Murji, Ally

doi:10.1016/j.jmig.2021.01.011

Cited by 22 publications

(13 citation statements)

References 29 publications

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“…Some studies suggest that younger women (aged <65 years) may require more opioids postoperatively, but data on age and postoperative opioid use specifically in the urogynecologic population are limited. [9][10][11][12] Excessive opioid prescribing can also lead to unused opioids being diverted from the intended use. More than 90% of patients reported keeping unused opioids in their homes, thereby increasing the likelihood of abuse and misuse by patients themselves, family members, and the wider community.…”

Section: Why This Mattersmentioning

confidence: 99%

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

Willis-Gray

Leazer

Sun

et al. 2022

UROGC

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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.

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Section: Why This Mattersmentioning

confidence: 99%

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

Willis-Gray

Leazer

Sun

et al. 2022

UROGC

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“…Post-operative pain remains a timely and relevant consideration for surgeons, as data suggests that 1 in 65 women who fill an opioid prescription after elective gynecologic surgery will 4 experience prolonged use, and the risk is higher with increased doses of opioids prescribed (10). Furthermore, it is estimated that 1 in 10 people with opioid dependence had their first exposure after a surgical procedure and women are 40% more likely than men to become persistent opioid users after surgery (11).…”

Section: Introductionmentioning

confidence: 99%

Does Size Matter? Opioid Use after Laparoscopy for Apical Pelvic Organ Prolapse Using an 8 mm versus 10—12 mm Accessory Port

Edwards

Ramirez

Scime

et al. 2022

Journal of Minimally Invasive Gynecology

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“… 8 Importantly, one in every 65 patients who initiate opioids after gynecologic surgery will experience prolonged use. 9 However, interventions to reduce opioid diversion through patient education have a positive effect. 10 , 11 Institution-based Enhanced Recovery After Surgery (ERAS) opioid-prescribing recommendations also result in reduced opioid overprescribing.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery

Frost

Kohn

Wang

et al. 2022

JSLS

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Background and Objectives: To evaluate postoperative opioid use after benign minimally-invasive gynecologic surgery and assess the impact of a patient educational intervention regarding proper opioid use/disposal. Methods: Educational pamphlets were provided preoperatively. Patients underwent hysterectomy, myomectomy, or other laparoscopic procedures. Opioid prescriptions were standardized with 25 tablets oxycodone 5mg for hysterectomy/myomectomy, 10 tablets oxycodone 5mg for LSC (oral morphine equivalents were maintained for alternatives). Pill diaries were reviewed and patient surveys completed during postoperative visits. Results: Of 106 consented patients, 65 (61%) completed their pill diaries. Median opioid use was 35 OME for hysterectomy (∼5 oxycodone tablets; IQR 11.25-102.5), 30 OME for myomectomy (∼4 tablets; IQR 15-75), and 18.75 OME for laparoscopy (∼3 tablets; IQR 7.5-48.75). Median last post-operative day (d) of use was 3d for hysterectomy (IQR 2, 8), 4d for myomectomy (IQR 1, 7), and 2d for laparoscopy (IQR 0.5-3.5). One patient (myomectomy) required a refill of 5mg oxycodone. No difference was found between total opioid use and presence of pelvic pain, chronic pain disorders, or psychiatric co-morbidities. Overall satisfaction with pain control (>4 on a 5-point Likert scale) was 91% for hysterectomy, 100% for myomectomy, 83% for laparoscopy. Of the 33 patients who read the pamphlet, 32(97%) felt it increased their awareness. Conclusion: Most patients required <10 oxycodone 5mg tablets, regardless of procedure with excellent patient satisfaction. A patient education pamphlet is a simple method to increase knowledge regarding the opioid epidemic and facilitate proper medication disposal.

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Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Cited by 22 publications

References 29 publications

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

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

Does Size Matter? Opioid Use after Laparoscopy for Apical Pelvic Organ Prolapse Using an 8 mm versus 10—12 mm Accessory Port

Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery

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