Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator
| Autor: | Keith B. Isaacson, M. Loring, S.N. Morris, Kelly N. Wright, Marron Wong, A. Vogell |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_treatment Endometriosis Inappropriate Prescribing Hysterectomy Risk Factors medicine Humans Prospective Studies Practice Patterns Physicians' Aged Pain Measurement Postoperative Care Pain Postoperative Past medical history business.industry Pelvic pain Obstetrics and Gynecology Middle Aged Opioid-Related Disorders medicine.disease Analgesics Opioid Massachusetts Opioid Health Care Surveys Anesthesia Morphine Female Laparoscopy Pain catastrophizing medicine.symptom business Oxycodone Follow-Up Studies medicine.drug |
| Zdroj: | American Journal of Obstetrics and Gynecology. 220:259.e1-259.e11 |
| ISSN: | 0002-9378 |
| DOI: | 10.1016/j.ajog.2018.10.022 |
| Popis: | Background In the setting of America’s opioid epidemic, judicious postoperative opioid prescribing is important. Gynecologists lack standard guidelines about postoperative opioid prescriptions. Objectives The objectives of the study were to describe opioid prescribing practices by a group of minimally invasive gynecologic surgeons, to measure postoperative opioid use after minimally invasive hysterectomy, and to identify preoperative factors that could predict whether a patient will be a low or high postoperative opioid user. Study Design This was a prospective survey-based study including 125 women undergoing laparoscopic hysterectomy for benign indications at 2 community teaching hospitals. Patients were preoperatively surveyed about demographics, past medical history, and current and expected pain scores and were screened for anxiety, depression, and pain catastrophizing. At 1 and 2 weeks after surgery, patients were surveyed about their pain and pain medication use. Results Ninety-eight percent of patients were prescribed an opioid for acute postoperative pain. The median opioid prescription was for 150 morphine milligram equivalents, equivalent to 20 tablets of oxycodone 5 mg, while median patient postoperative use was 37.5 morphine milligram equivalents, equivalent to 5 tablets of oxycodone 5 mg. Ninety percent of patients had leftover opioids at 2 weeks after surgery, and most leftover opioids were stored in an unsecure location. Preoperative factors that were most strongly correlated with postoperative opioid use included a history of chronic pelvic pain or endometriosis, preoperative opioid use, anxiety, depression, pain catastrophizing, preoperative pain score, anticipated postoperative pain score, and anticipated postoperative pain medication needs. A predictive calculator was developed based on these factors to help identify patients who are likely to be a high opioid user (defined as taking greater than 112.5 morphine milligram equivalents) or a low opioid user (defined as taking 37.5 morphine milligram equivalents or less). Conclusion On average, surgeons prescribed 4 times the amount of opioids than was needed for patients undergoing laparoscopic hysterectomy for acute postoperative pain control. Individualizing patients’ opioid prescriptions based on preoperative risk factors could help reduce excess prescription opioids. |
| Databáze: | OpenAIRE |
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