The following is a summary of “Perioperative opioid dispensing and persistent use after benign hysterectomy: a systematic review and meta-analysis,” published in the JULY 2023 issue of Obstetrics and Gynecology by Hessami, et al.
For a meta-analysis, researchers sought to achieve two primary objectives: to assess the quantity and dosage of opioids dispensed perioperatively for benign hysterectomy based on the procedure route and to identify predictors of persistent opioid use after the procedure.
A systematic search was conducted on PubMed, Web of Science, and Embase, covering studies from their inception to March 25, 2022. They included studies reporting data on opioid dispensing in patients undergoing benign hysterectomy. The primary outcome focused on the perioperative opioid dosage (from 30 days preoperatively to 21 days postoperatively). The secondary outcome was the identification of predictors associated with persistent opioid use following benign hysterectomy (from 3 months to 3 years postoperatively). Opioid dispensing was measured in morphine milligram equivalents (MME). Using a random-effects model, we pooled the mean differences or odds ratios and their corresponding 95% CI.
The meta-analysis incorporated data from 8 studies, encompassing 377,569 women who underwent benign hysterectomy. Among these patients, 83% (95% CI, 81–84) received opioids during the perioperative period. On average, the perioperatively dispensed opioids amounted to 143.5 morphine milligram equivalents (95% CI, 40–247). Notably, patients undergoing vaginal hysterectomies received significantly lower amounts of opioids than those undergoing laparoscopic or abdominal hysterectomies.
The overall rate of persistent opioid use after benign hysterectomy was 5% (95% CI, 2–8). Younger patient age (odds ratio, 1.38; 95% CI, 1.17–1.63), smoking history (odds ratio, 1.87; 95% CI, 1.67–2.10), alcohol use (odds ratio, 3.16; 95% CI, 2.34–4.27), back pain (odds ratio, 1.50; 95% CI, 1.10–2.05), and fibromyalgia (odds ratio, 1.60; 95% CI, 1.39–1.83) were significantly associated with a higher risk of persistent opioid use after benign hysterectomy. However, the route of hysterectomy and operative complexity did not significantly predict persistent opioid use postoperatively.
The quantity of perioperatively dispensed opioids showed significant variation based on the route of hysterectomy, with vaginal hysterectomy resulting in the lowest morphine milligram equivalents dispensed and abdominal hysterectomy with the highest. Nonetheless, the route of hysterectomy did not emerge as a significant predictor of persistent opioid use after the procedure. Instead, factors such as younger age, smoking, alcohol use, back pain, and fibromyalgia were significantly associated with persistent opioid use following a benign hysterectomy.