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Postoperative Opioid Prescribing Following Gynecologic Surgery for Pelvic Organ Prolapse

Leach, D. Allan MD; Habermann, Elizabeth B. PhD; Glasgow, Amy E. MHA; Occhino, John A. MD, MS

Female Pelvic Medicine & Reconstructive Surgery: September 22, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000628
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Objectives The aim of this study was to evaluate postoperative pain scores, quantity of prescribed opioids at hospital discharge, and need for additional opioid prescriptions among women undergoing surgical treatment of pelvic organ prolapse.

Methods Institutional billing data were used to identify all patients undergoing pelvic reconstructive surgery between January 1, 2012, and May 30, 2017. Inpatient records were utilized to obtain prescription data (reported in oral morphine equivalents for standardization) and pain scores. The cohort was organized by surgical approach (open, endoscopic, vaginal), number of concomitant procedures, and patient age stratified by decade. These factors were then matched to postoperative pain scores, amount of opioid prescribed at discharge, and number of subsequent opioid refills. Pain scores and opioid use were also compared for correlation.

Results One thousand eight hundred thirty patients underwent surgical treatment of pelvic organ prolapse and met criteria for study participation. A significant decrease in pain scores, mean oral morphine equivalents prescribed, and opioid refill rates was seen with increasing patient age by decade regardless of surgical approach. Pain scores were significantly different only between patients undergoing vaginal surgery with 0 concomitant procedures versus 1 or more concomitant procedures. Finally, pain scores were directly correlated to the amount of opioid prescribed.

Conclusions Pain scores, opioid prescription amounts, and refills varied by patient age and surgical approach but were unaffected by concomitant procedures. Further work in correlating pain scores to opioid utilization is needed to ensure appropriate prescribing patterns and reduce risks of opioid dependence and diversion.

From the Division of Gynecologic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.

Correspondence: D. Allan Leach, MD, Division of Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: Leach.Douglas@mayo.edu.

This study was conducted entirely in Rochester, MN.

The authors have declared they have no conflicts of interest.

D.A.L. is a member of the US Armed Forces; the views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of this government agency.

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