Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

Abstract

<b><i>Objectives:</i></b> This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. <b><i>Design:</i></b> This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. <b><i>Methods:</i></b> Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum <i>t</i> tests for OMEs and χ<sup>2</sup> <i>t</i> tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). <b><i>Results:</i></b> In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (<i>p</i> < 0.0001). The opioid refill rate remained unchanged at 7.4% (<i>p</i> = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (<i>p</i> < 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; <i>p</i> = 0.739). <b><i>Limitations:</i></b> Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. <b><i>Conclusions:</i></b> Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

Abdominal hysterectomy and postoperative quality of recovery: emphasis on pain relief

“…В останні роки у США застосування опіатів після гістеректомії значно скоротилося [16]. У нещодавному метааналізі було доведено, що проведення попереджувальної аналгезії з використанням наркотичних або ненаркотичних знеболювальних засобів у пацієнток, яким проводили абдомінальну гістеректомію, приводило до зниження потреби в опіоїдних анальгетиках та покращення показників за шкалою болю, а також сприяло підвищенню рівня задоволеності лікуванням [17].…”

Perioperative managment for gynecological surgery in accelerated rehabilitation programme

“…The anaesthesiologist's preoperative examination should include an assessment of surgical risks, primarily the risk of death, the predictors of which are body mass index ≥ 50 kg/m², gender, hypertension, risk of pulmonary embolism, and age ≥ 45. 13,27,36,39 In addition, special attention should be paid to the assessment of the respiratory tract and cardiovascular status of women. 14,[32][33][34] An important step in the implementation of the FTS concept is preoperative preparation, which includes the following items: risk stratification, smoking cessation, prevention of bacterial complications, fasting before surgery, colon preparation, refusal of premedication, and antimicrobial prophylaxis one hour before surgery is equally important.…”

“…8,34 Adequate psychological preparation and patient awareness of pain relief can reduce the need for opioids and sedatives during the intraoperative and postoperative stages. 35,36 At the same time, it is advisable to assess the nutritional status of the woman, the presence of protein and energy deficiency, as well as the state of the erythrocyte sprout. Correction of anaemia at the preoperative stage and perioperative intravenous administration of iron supplements can reduce the probability of haemotransfusion, reduce treatment costs and length of hospital stay.…”