Opioid Prescription and Patient Use After Gynecologic Procedures: A Survey of Patients and Providers

Griffith, Kendall C.; Clark, Nisse V.; Zuckerman, Andrea; Ferzandi, Tanaz R.; Wright, Kelly

doi:10.1016/j.jmig.2017.11.005

Cited by 42 publications

(21 citation statements)

References 12 publications

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“…One study in Boston compared the prescribing patterns and usage of opioids following minimally invasive and abdominal hysterectomies. They found that 64.6% of patients used less than half of prescribed opioids, and that 16.1% of patients did not use any of their prescribed pills . A separate study from Massachusetts asked patients to complete a questionnaire “regarding the number of tablets prescribed and used” 2 weeks following urogynecologic and reconstructive surgeries .…”

Section: Introductionmentioning

confidence: 99%

Opioid prescribing practices and medication use following urogynecological surgery

Solouki

Plummer

Agalliu

et al. 2018

Neurourology and Urodynamics

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Background: Opioid abuse is a growing epidemic in the United States, with opioid overdose becoming a leading cause of death. There is wide variation in prescription practices for post-operative opioids due to absence of guidelines. The purpose of this study is to examine postoperative opioid prescribing patterns after urogynecologic surgery and determine usage and management of opioid pills by patients. Materials and Methods: This is an observational, prospective study of female patients (N = 143) who underwent urogynecologic (prolapse or incontinence) surgery from June to December 2017 at a single academic center. Patients were surveyed regarding their pain medication use 30 days postoperatively. Survey questions included preoperative pain medication use, quantity of opioid pills consumed, need for additional opioid prescription, and management of remaining pills. T-test and one-way Anova were used for comparison of continuous variables and chi-squared test used for comparison of categorical variables. Results: Of 143 eligible patients, 99 (69%) responded; 62% of respondent patients underwent vaginal surgery, 22% abdominal surgery with or without vaginal surgery, and 15% underwent other procedures. Postoperatively, 81.8% of patients were prescribed opioids. The average number of tablets prescribed ranged from 12.4 to 17.4 depending on the procedure. 54.3% of patients reported using less than half of their prescribed opioid prescription. Of the patients who had excess opioid tablets, only 8.6% reported discarding their opioids. Conclusion: To date, no guidelines exist on prescribing opioids postoperatively.Opioids are overprescribed post-operatively with over half of patients using less than half of the opioids prescribed to them. K E Y W O R D S opioid, postoperative, urogynecology

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Section: Introductionmentioning

confidence: 99%

Opioid prescribing practices and medication use following urogynecological surgery

Solouki

Plummer

Agalliu

et al. 2018

Neurourology and Urodynamics

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“…Our survey response rate was nearly 60%, with potential that the data from the missing 40% of the patient cohort may have altered the associations identified among total opioid use among physician ERAS-adherence groups. The duration of the study period was determined based on the goal of recruiting and surveying over 100 study participants, consistent with the sample size of prior similar investigations [4,5]. However, we were only able to include a small number of vaginal hysterectomies as well as vaginal and vulvar surgeries and would have benefited from a longer study period to better comment on the role of opioid use in these groups.…”

Section: Discussionmentioning

confidence: 99%

“…Opioid overprescribing after benign gynecology surgery could result from heterogeneous physician-prescribing patterns [5]. The absence of a national consensus guideline regarding postoperative analgesic management and varying professional opinions regarding opioid prescribing has led many institutions to implement their own postoperative opioid prescribing recommendations as a component of their Enhanced Recovery After Surgery (ERAS) protocols.…”

mentioning

confidence: 99%

Postoperative Opioid Use Using Enhanced Recovery After Surgery Guidelines for Benign Gynecologic Procedures

Movilla

Kokroko

Kotlyar

et al. 2020

Journal of Minimally Invasive Gynecology

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To evaluate opioid use after benign gynecologic surgery after implementation of Enhanced Recovery After Surgery (ERAS) opioid prescribing recommendations. Design: A prospective cohort study. Setting: An academic tertiary care hospital. Patients: All patients undergoing elective benign gynecologic surgery at a large academic institution between August 2017 and December 2017, 1 year after ERAS postoperative opioid prescribing recommendations were implemented for the benign gynecologic surgery department. Interventions: A chart review determining opioid prescription quantity and a patient telephone survey 7 days after surgery were both performed. Total opioid use was calculated. Physician adherence to the institution's ERAS postoperative opioid prescribing recommendations after benign gynecologic surgery was then determined. Patients were classified as either in the physician adherent to ERAS group or the physician nonadherent to ERAS group. After this stratification, patients' total opioid use within each group was then compared. Measurements and Main Results: A total of 241 consecutive benign gynecologic surgical procedures were reviewed. Opioids were prescribed for outpatient postoperative pain management in 186 (77.2%) of these procedures. Physician adherence to the ERAS postoperative opioid prescribing recommendations occurred in 150 (62.2%) of all surgical cases. The telephone survey was completed by 144 (59.8%) patients 7 days after their surgery. Among survey participants, a total of 13 783.5 morphine milligram equivalents (MMEs) or 64.7% of all opioids prescribed were unused 7 days after surgery. This is equivalent to 1838 oxycodone 5-mg tablets unused by the end of the study period. For all surgical procedure types, the ERAS-nonadherent group was prescribed statistically significantly more opioids per patient than the ERAS-adherent group (246.2 § 22.8 MME vs 81.1 § 6.2 MME, p < .005), resulting in more opioids unused among the ERAS-nonadherent group. Consequently, the ERAS-nonadherent group contributed 63.5% (8747.5 MMEs) of the total unused opioids by the end of the study period despite only making up 39.6% of the completed patient surveys. Conclusion: Patients require significantly less opioids after benign gynecologic surgery than they are being prescribed. Physician adherence to the ERAS postoperative opioid recommendations is suboptimal and contributes significantly to the quantity of unused opioids after surgery for benign gynecologic indications. Almost two thirds of all opioids prescribed are not used by 1 week after benign gynecologic surgery.

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“…We chose to investigate the effects of a new standard low-tablet number opioid prescription in the ambulatory surgery setting. Although robotic surgeries and laparoscopic hysterectomies may have similar analgesic requirements [1,3,11,12] and may be done in an outpatient setting, we wanted to focus on common ambulatory surgeries. There are not sufficient data available to guide prescribing practices in this population.…”

Section: Tablementioning

confidence: 99%

Examining Reduced Opioid Prescriptions after Gynecologic Laparoscopy: A Randomized Controlled Trial

Plewniak

Kintzer

Eisenberg

et al. 2021

Journal of Minimally Invasive Gynecology

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To examine whether prescribing 5 tablets, as opposed to 10 tablets, of 5-mg oxycodone adequately treats pain after gynecologic laparoscopy. Design: Single-blinded randomized trial. Setting: Academically affiliated ambulatory surgery center. Patients: One hundred twenty women scheduled to undergo minor gynecologic laparoscopy. Interventions: Patients scheduled for ambulatory gynecologic laparoscopy were allocated to the standard tablet or low-tablet number prescription groups (10 tablets or 5 tablets of 5-mg oxycodone). The patients also received prescriptions for acetaminophen and ibuprofen. Measurements and Main Results: Telephone surveys were conducted on postoperative days 1 and 7 to assess medication use and pain. The primary outcome was the number of oxycodone tablets used by days 1 and 7. Prespecified secondary outcomes included unscheduled patient contacts and pain scores. With N = 50 in each group and assuming standardized effect sizes, the study was powered to detect a 0.6 difference or greater when comparing the primary outcome between the groups. Forty-five and 47 patients in the 5-tablet and 10-tablet groups, respectively, completed the day-7 survey. The median number of oxycodone tablets taken by day 7 was 2.0 (interquartile range 0.0, 4.0) in the 5-tablet group and 2.5 (interquartile range 0.0, 5.0) in the 10-tablet group (p = .36). Most of the patients in both groups reported taking 3 oxycodone tablets or fewer by day 7. There were no significant differences in unscheduled patient contacts, need for additional prescriptions, or pain scores. There were significantly fewer unused tablets in the 5-tablet group by day 7. Conclusion: Prescribing 5 tablets of 5-mg oxycodone, acetaminophen, and ibuprofen is likely sufficient for most patients after minor laparoscopic surgery.

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Opioid Prescription and Patient Use After Gynecologic Procedures: A Survey of Patients and Providers

Cited by 42 publications

References 12 publications

Opioid prescribing practices and medication use following urogynecological surgery

Opioid prescribing practices and medication use following urogynecological surgery

Postoperative Opioid Use Using Enhanced Recovery After Surgery Guidelines for Benign Gynecologic Procedures

Examining Reduced Opioid Prescriptions after Gynecologic Laparoscopy: A Randomized Controlled Trial

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