Trends in patient procurement of postoperative opioids and route of hysterectomy in the United States from 2004 through 2014

Thompson, Jennifer C.; Komesu, Yuko M.; Qeadan, Fares; Jeppson, Peter C.; Cichowski, Sara; Rogers, Rebecca G.; Mazurie, Aurélien; Nestsiarovich, Anastasiya; Lambert, Christophe G; Dunivan, Gena C.

doi:10.1016/j.ajog.2018.07.003

Cited by 34 publications

(25 citation statements)

References 29 publications

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“…Gynecologic procedures account for 7.7% of all surgeries performed in women representing an important generator of opioid prescriptions 10 . Hysterectomy is the most common gynecologic surgery performed and the current literature largely explores opioid use exclusively for hysterectomy 5,9,[11][12][13] . Much less is known about opioid prescribing trends and rates of persistent use following non-hysterectomy gynecologic surgeries.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Chan

Lam

et al. 2021

Journal of Minimally Invasive Gynecology

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Section: Introductionmentioning

confidence: 99%

Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Chan

Lam

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Expectations for no pain after surgery, as well as aggressive marketing to physicians from drug companies have led to increased use of opioids in the perioperative setting. For example, opioid prescriptions increased significantly from 2004 to 2014 in women undergoing hysterectomy for benign indications, even though less invasive techniques have emerged in recent years [7].…”

Section: Introductionmentioning

confidence: 99%

Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures

et al. 2020

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Background The rise in deaths attributed to opioid drugs has become a major public health problem in the United States and in the world. Minimally invasive surgery (MIS) is associated with a faster postoperative recovery and our aim was to investigate if the use of MIS was associated with lower odds of prolonged opioid prescriptions after major procedures. Methods Retrospective study using the IBM Watson Health Marketscan® Commerical Claims and Encounters Database investigating opioid-naïve cancer patients aged 18–64 who underwent open versus MIS radical prostatectomy (RP), partial colectomy (PC) or hysterectomy (HYS) from 2012 to 2017. Propensity weighted logistic regression analyses were used to estimate the independent effect of surgical approach on prolonged opioid prescriptions, defined as prescriptions within 91–180 days of surgery. Results Overall, 6838 patients underwent RP (MIS 85.5%), 4480 patients underwent PC (MIS 61.6%) and 1620 patients underwent HYS (MIS 41.8%). Approximately 70–80% of all patients had perioperative opioid prescriptions. In the weighted model, patients undergoing MIS were significantly less likely to have prolonged opioid prescriptions in all three surgery types (Odds Ratio [OR] 0.737, 95% Confidence Interval [CI] 0.595–0.914, p = 0.006; OR 0.728, 95% CI 0.600–0.882, p = 0.001; OR 0.655, 95% CI 0.466–0.920, p = 0.015, respectively). Conclusion The use of the MIS was associated with lower odds of prolonged opioid prescription in all procedures examined. While additional studies such as clinical trials are needed for further confirmation, our findings need to be considered for patient counseling as postoperative differences between approaches do exist.

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“…In contrast, Thompson et al demonstrated an increase in opioid prescriptions after hysterectomy from 2004 to 2014, despite a concomitant increase in minimally invasive routes. 10 Our more recent time period of 2016 to 2019 suggests a shift in trends towards more judicious opioid prescribing among gynecologists. Alternatively, this may reflect cultural or individual physician practices at our institution.…”

Section: Resultsmentioning

confidence: 99%

“…9 Despite this, there are few evidenced-based guidelines informing gynecologic surgeon prescribing. 10 Enhanced recovery after surgery protocols encourage multimodal, opioid-sparing, postoperative pain-control and recommend prescribers account for patient factors when prescribing postoperative opioids, but explicit prescribing regimens and procedure specific recommendations are lacking. 11 This study seeks to contribute to the literature on opioid prescribing patterns after gynecologic surgery by focusing on laparoscopic sterilization.…”

Section: Introductionmentioning

confidence: 99%

Trends in Opioid Prescriptions after Laparoscopic Sterilization

Arabkhazaeli¹,

Umeh²,

Khaksari³

et al. 2021

JSLS

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Background and Objectives: Examine trends in opioid prescriptions after laparoscopic sterilization over time, and identify any individual patient, provider, or procedural factors influencing prescribing.Methods: A retrospective observational cohort analysis of laparoscopic sterilizations between January 1, 2016 and December 31, 2019 at Montefiore Medical Center. A review of the medical records was performed and information on patient demographics, comorbid conditions, and surgical characteristics were collected. The number of opioid pills prescribed postoperatively and any pain related patient calls, visits, or refills was recorded.Results: Between January 1, 2016 and December 31, 2019, 615 laparoscopic sterilizations were performed. The median number of opioid pills prescribed was 10, ranging from 0 to 40. There was a significant decrease in the number of opioid pills prescribed (p < .0001) and refill incidence (p < .001) over time. Patients with a documented diagnosis of pelvic pain received significantly more opioid pills (p = .02), as did patients who underwent tubal occlusion versus salpingectomy (p = .01). There was no association between the number of opioid pills prescribed and other patient or procedural characteristics. Finally, the number of pills prescribed was not associated with urgent patient contact (p = .34). Conclusions:The overall number of opioid pills prescribed after laparoscopic sterilization decreased at our institution over time, which paralleled a decrease in refills and urgent postoperative patient contact. Further, few clinical characteristics influenced postoperative prescribing and there was no association between number of pills prescribed and urgent patient contact. These findings suggest excess prescribing and highlight the need to identify and adopt an evidenced-based approach to postsurgical opioid prescriptions.

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Trends in patient procurement of postoperative opioids and route of hysterectomy in the United States from 2004 through 2014

Cited by 34 publications

References 29 publications

Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures

Trends in Opioid Prescriptions after Laparoscopic Sterilization

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