Abstract
Introduction and hypothesis
Understanding demographic and opioid utilization patterns of preoperative opioid users compared with opioid-naïve patients undergoing surgical treatment for pelvic organ prolapse (POP) better informs opioid prescribing.
Methods
A cohort of preoperative opioid users undergoing surgery for POP from 1 January 2012 through 30 May 2017 was identified. Electronic medical records were utilized to obtain pain scores and prescription data. The cohort was organized by surgical approach, number of concomitant procedures, and patient age. These factors were then matched to pain scores, opioid quantity prescribed at discharge, and subsequent refills. Pain scores and opioid use were evaluated for correlation. Results were then compared with similar data previously published for opioid-naïve patients undergoing surgical treatment of POP.
Results
Preoperative opioid users were younger (55.5 [14.7] vs 59.5 [12.7]; p = 0.002), of higher body mass index (BMI; 29.2 [5.4] vs 28.6 [10.3]; p = 0.04), and less likely Caucasian (90.3% vs 95.9%; p = 0.002) than opioid-naïve patients. After matching for these differences, opioid users reported higher pain scores (3.5 [2.2] vs 2.6 [1.8]; p = <0.0001), but received similar opioid quantities (324.4 [395] vs 296 [158] oral morphine equivalents [OME]; p = 0.27; 16.8% vs 10.4% refill rates; p = 0.07). In preoperative opioid users, neither surgical approach nor the number of concomitant procedures influenced pain scores. Increasing mean pain scores (1.8 [2.0] to 4.2 [2.4]; p < 0.002) and OME prescribed (226 [170.2] to 541 [902.5] p = 0.056; 0% to 22.2% refill rates; p = 0.02), were seen with decreasing patient age. Pain scores correlated directly with the opioid amount prescribed.
Conclusions
Patient age and preoperative opioid utilization should be factored into urogynecological postoperative opioid-prescribing protocols.
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DAL: project development, data collection, data analysis, manuscript writing; LSS: data analysis, manuscript writing; EBH: project development, data analysis, and manuscript writing; AEG: data collection, data analysis, manuscript writing; JAO: project development, data analysis, manuscript writing.
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Dr. Leach and Dr. Scarlotta are members 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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Leach, D.A., Scarlotta, L.S., Habermann, E.B. et al. Characteristics of opioid users undergoing surgery for pelvic organ prolapse. Int Urogynecol J 31, 1891–1897 (2020). https://doi.org/10.1007/s00192-019-04215-1
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DOI: https://doi.org/10.1007/s00192-019-04215-1