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Opioid Prescribing Patterns, Patient Use, and Postoperative Pain After Hysterectomy for Benign Indications

As-Sanie, Sawsan MD, MPH; Till, Sara R. MD, MPH; Mowers, Erika L. MD; Lim, Courtney S. MD; Skinner, Bethany D. MD; Fritsch, Laura BS; Tsodikov, Alex PhD; Dalton, Vanessa K. MD, MPH; Clauw, Daniel J. MD; Brummett, Chad M. MD

doi: 10.1097/AOG.0000000000002344
Contents: Original Research
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OBJECTIVE: To quantify physician prescribing patterns and patient opioid use in the 2 weeks after hysterectomy at an academic institution and to determine whether patient factors predict postsurgical opioid use and pain recovery.

METHODS: We conducted a prospective quality initiative study by recruiting all English-speaking patients undergoing hysterectomy for benign, nonobstetric indications at a university hospital between August 2015 and December 2015, excluding those with major medical morbidities or substance abuse. Before hysterectomy, patients completed the Fibromyalgia Survey, a validated measure of centralized pain. After hysterectomy, opioid use (converted to oral morphine equivalents) and pain scores (0–10 numeric rating scale) were collected by a daily diary and a structured telephone interview 14 days after surgery. Primary outcomes were total opioid prescribed and consumed in the 2 weeks after hysterectomy. Secondary outcomes included daily opioid use and daily pain severity for 14 days after hysterectomy.

RESULTS: Of 103 eligible patients, 102 (99%) agreed to participate, including 44 (43.1%) laparoscopic, 42 (41.2%) vaginal, and 16 (15.7%) abdominal hysterectomies. Telephone surveys were completed on 89 (87%) participants; diaries were returned from 60 (59%) participants. Diary nonresponders had different baseline characteristics than nonresponders. Median amount of opioid prescribed was 200 oral morphine equivalents (interquartile range 150–250). Patients reported using approximately half of the opioids prescribed with a median excess of 110 morphine equivalents (interquartile range 40–150). The best fit model of total opioid consumption identified preoperative Fibromyalgia Survey Score, overall body pain, preoperative opioid use, prior endometriosis, abdominal hysterectomy (compared with laparoscopic), and uterine weight as significant predictors. Highest tertile of Fibromyalgia Survey Score was associated with greater daily opioid consumption (13.9 [95% CI 3.0–24.8] greater oral morphine equivalents at baseline, P=.02).

CONCLUSION: Gynecologists at a large academic medical center prescribe twice the amount of opioids than the average patient uses after hysterectomy. A personalized approach to prescribing opioids for postoperative pain should be considered.

Gynecologists in a large academic medical center prescribe approximately twice the amount of opioids than the average patient uses after hysterectomy.

Departments of Obstetrics and Gynecology, Anesthesiology, and Internal Medicine, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, the Department of Biostatistics, School of Public Health, University of Michigan, and the Department of Obstetrics and Gynecology, St Joseph Mercy Hospital, Ann Arbor, Michigan.

Corresponding author: Sawsan As-Sanie, MD, MPH, Department of Obstetrics and Gynecology, University of Michigan Medical School, L4100 Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109; email: sassanie@med.umich.edu.

Financial Disclosure Dr. As-Sanie has been a consultant for Daichii Sankyo and Abbvie. Dr. Dalton has been a consultant for Bayer. Dr. Clauw provided the following disclosures: Abbott Pharmaceutical Products Division: consultant, advisory, strategic, scientific or medical board; Aptinyx: consultant; Astellas Pharmaceutical: advisory, strategic, scientific or medical board; Cerephex: consultant, advisory, strategic, scientific or medical board; Daiichi Sankyo: consultant; Pfizer, Inc: expert witness, consultant, advisory, strategic, scientific or medical board; Pierre Fabre: lecturer; Samumed, Theravance, and Tonix: consultant; Williams & Connolly LLP: expert witness; Zynerba: advisory, strategic, scientific, or medical board. He has also received research support from Aptinyx, Cerephex, and Pfizer. Dr. Brummett receives research funding from Neuros Medical, LLC. The other authors did not report any potential conflicts of interest.

Supported in part by National Institutes of Health grants R01 HD088712, R01 DA038261, R01 DA042859, and P50 AR070600.

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.