To examine opioid prescribing and consumption patterns after hysterectomy and identify factors associated with post-operative opioid consumption.
Prospective cohort study.
Single university medical center.
Women undergoing hysterectomy for benign, non-obstetric indications.
Participant pre-operative and surgical characteristics were obtained through chart review and patient report of baseline pain score. During the third post-operative week, participants completed a telephone interview, including direct count of remaining opioid pills and assessment of satisfaction with pain management. We assessed factors associated with opioid consumption in oral morphine equivalents using a linear regression model.
Of the 129 participants, 113 (88%) completed the post-operative survey after hysterectomy: 16 vaginal, 43 robotic-assisted, 42 conventional laparoscopic, and 12 abdominal hysterectomies. The median amount of opioid prescribed was 150 oral morphine equivalents (interquartile range (IQR) 113-200), while the median amount consumed was 75 (IQR 10-135), reflecting an average consumption of about 50% of the prescription. Opioid prescription size was associated with consumption; for every additional one oral morphine equivalent prescribed, on average, an additional 0.5 was consumed (P<.001). If the indication for hysterectomy was related to pain, participants consumed 25.3 additional oral morphine equivalents (P=.04). The amount of opioid prescribed was inversely correlated with pain management satisfaction; every additional point on a 1 through 5 Likert scale of increasing satisfaction was associated with 44 fewer OME prescribed (standard error 9 OME, P<.001). For the 1,464 total unused pills among the 104 participants with leftover opioids, only 20% reported an FDA-compliant opioid disposal plan.
Gynecologic surgeons can respond to the opioid epidemic by reducing excess opioid pills after hysterectomy: providing both the smallest effective prescription size as well as concrete resources for safe opioid disposal. These actions may contribute to a reduction in opioid use disorder cases or overdose deaths.
Copyright © 2020. Published by Elsevier Inc.