Postoperative Opioid Prescribing Following Gynecologic Surgery for Pelvic Organ Prolapse.

Szczegóły
Abstrakt

Tytuł:: Postoperative Opioid Prescribing Following Gynecologic Surgery for Pelvic Organ Prolapse.
Autorzy:: Leach DA; 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.
Habermann EB
Glasgow AE
Occhino JA
Źródło:: Female pelvic medicine & reconstructive surgery [Female Pelvic Med Reconstr Surg] 2020 Sep; Vol. 26 (9), pp. 580-584.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins
MeSH Terms:: Analgesics, Opioid/*therapeutic use
Pain, Postoperative/*drug therapy
Pelvic Organ Prolapse/*surgery
Practice Patterns, Physicians'/*statistics & numerical data
Adult ; Aged ; Female ; Humans ; Middle Aged ; Pain Measurement/methods ; Retrospective Studies
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Owens PL (AHRQ), Barrett ML (M. L. Barrett, Inc.), Weiss AJ (Truven Health Analytics), et al. Hospital inpatient utilization related to opioid overuse among adults, 1993–2012. HCUP Statistical Brief #177. August 2014. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb177-Hospitalizations-for-Opioid-Overuse.pdf. Accessed December 5, 2017.
Paulozzi LJ, Weisler RH, Patkar AA. A national epidemic of unintentional prescription opioid overdose deaths: how physicians can help control it. J Clin Psychiatry 2011;72(5):589–592.
Rudd RA, Seth P, David F, et al. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65(5051):1445–1452.
Florence CS, Zhou C, Luo F, et al. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 2016;54(10):901–906.
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Hooten WM, St Sauver JL, Mcgree ME, et al. Incidence and risk factors for progression from short-term to episodic or long-term opioid prescribing: a population-based study. Mayo Clin Proc 2015;90(7):850–856.
Bates C, Laciak R, Southwick A, et al. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol 2011;185(2):551–555.
Calcaterra SL, Yamashita TE, Min SJ, et al. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med 2016;31(5):478–485.
Brummett CM, Waljee JF, Goesling J. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017;152(6):e170504.
Opioid Prescribing Work Group: Opioid prescribing guideline, Minnesota Department of Human services. November 2017. Available at: https://mn.gov/dhs/assets/draft-complete-set-of-recommendations_tcm1053-319378.pdf. Accessed December 5, 2017.
Thiels CA, Anderson SS, Ubl DS, et al. Wide variation and overprescription of opioids after elective surgery. Ann Surg 2017;266(4):564–573.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep 2016;65:1–49.
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Substance Nomenclature:: 0 (Analgesics, Opioid)
Entry Date(s):: Date Created: 20180925 Date Completed: 20211001 Latest Revision: 20211001
Update Code:: 20240105
DOI:: 10.1097/SPV.0000000000000628
PMID:: 30247167
: Czasopismo naukowe

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.

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