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Use and Misuse of Opioids After Gynecologic Surgical Procedures

Wright, Jason D. MD; Huang, Yongmei MD, MPH; Melamed, Alexander MD, MPH; Tergas, Ana I. MD, MPH; St. Clair, Caryn M. MD; Hou, June Y. MD; Khoury-Collado, Fady MD; Ananth, Cande V. PhD, MPH; Neugut, Alfred I. MD, PhD; Hershman, Dawn L. MD

doi: 10.1097/AOG.0000000000003358
Contents: Gynecologic Surgery: Original Research
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OBJECTIVE: To examine the rate of opioid use for gynecologic surgical procedures and to investigate persistent opioid use among those women who received an initial opioid prescription.

METHODS: A retrospective cohort study using the MarketScan database was performed. MarketScan is a claims-based data source that captures claims from more than 50 million privately insured patients and 6 million Medicaid enrollees from 12 states. We identified women who underwent major and minor gynecologic surgery from 2009 to 2016. Among women who received an opioid prescription, new persistent opioid use was defined as receipt of one or more opioid prescriptions from 90 to 180 days after surgery with no intervening additional procedures or anesthesia. Multivariable models were used to examine associations between clinical characteristics and any use and new persistent use of opioids.

RESULTS: A total of 729,625 patients were identified. Overall, 60.0% of patients received a perioperative opioid prescription. Receipt of an opioid prescription ranged from 36.7% in those who underwent dilation and curettage to 79.5% of patients who underwent minimally invasive hysterectomy. Among patients who received a perioperative opioid prescription, the rate of new persistent opioid use overall was 6.8%. The rate of new persistent opioid use was 4.8% for myomectomy, 6.6% for minimally invasive hysterectomy, 6.7% for abdominal hysterectomy, 6.3% for endometrial ablation, 7.0% for tubal ligation, and 7.2% for dilation and curettage (P<.001). In a multivariable model, patients who underwent dilation and curettage and endometrial ablation were at highest risk for new persistent opioid use. Younger patients, Medicaid recipients, and patients with depression, anxiety, and substance use disorder more commonly had new persistent opioid use (P<.001 for all). Among women who received an opioid prescription, the rate of new persistent opioid use decreased over time from 7.0% in 2010 to 5.5% in 2016 (P<.001).

CONCLUSION: The rate of new persistent opioid use after major and minor gynecologic procedures is substantial.

The rate of new persistent opioid use after major and minor gynecologic procedures is substantial.

Columbia University College of Physicians and Surgeons, the Joseph L. Mailman School of Public Health, Columbia University, the Herbert Irving Comprehensive Cancer Center, and New York Presbyterian Hospital, New York, New York; Massachusetts General Hospital, Boston, Massachusetts; and Rutgers Robert Wood Johnson Medical School and the Environmental and Occupational Health Sciences Institute (EOHSI), Piscataway, New Jersey.

Corresponding author: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; email: jw2459@columbia.edu.

Financial Disclosure Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. Dr. Neugut has served as a consultant to Pfizer, Teva, Otsuka, Hospira, and United Biosource Corporation. He is on the scientific advisory board of EHE, Intl. Dr. Hershman is the recipient of a grant from the Breast Cancer Research Foundation/Conquer Cancer Foundation. The other authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews are available at http://links.lww.com/AOG/B428.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.