Opioid Consumption After Urogynecologic Surgery: A Prospective Multicenter Observational Study Using a Text-Messaging Survey Tool

Abstract

Importance Understanding postoperative opioid consumption is key to reducing opioid misuse.Objective The aim of the study was to quantify the amount of outpatient opioids consumed after urogynecologic surgery. Study Design This is a prospective multicenter cohort study sponsored by the American Urogynecologic Society Fellow's Pelvic Research Network. Women undergoing pelvic organ prolapse or urinary incontinence surgery between May 2019 and January 2021 were included. Patients used text messaging to report daily opioid consumption, pain levels, and nonopioid analgesic consumption 2 weeks postoperatively. Demographic and perioperative factors associated with high opioid use (>75th percentile) were identified. Results Two hundred sixty-one patients were included from 9 academic centers. The median (interquartile range) morphine milligram equivalents (MME) consumed were 28 (0-65) and prescribed were 75 (50-113). The median ibuprofen and acetaminophen tablets consumed were 19 (10-34) and 12 (4-26). The median pain level was 2.7 of 10 (1.7-4.4). Factors associated with high MME use (>65 MME) included body mass index greater than 30 ( P < 0.01), chronic pain ( P < 0.01), elevated baseline pain score ( P < 0.01), elevated blood loss ( P < 0.01), longer operating time ( P < 0.01), and southern region ( P < 0.01). High MME consumers more frequently underwent perineorrhaphy ( P = 0.03), although this was not significant on multivariate analysis. Conclusions Urogynecology patients consume a median of 28 MME (3-4 oxycodone 5-mg tablets) after surgery, and surgeons prescribe 3 times this amount (75 MME, 10 oxycodone tablets). In addition, there are several factors that can be used to identify patients who will require greater numbers of opioids. These data may be used to enhance existing prescribing guidelines.

Randomized Trial on Expectations and Pain Control Advancement in Surgery: The REPAIR Study

“…Investigators agreed that a 33% decrease in opioid consumption between groups after hospital discharge would be a clinically relevant difference and assumed that controls would consume a mean of fifteen 5-mg oxycodone pills with a standard deviation of ±11 pills. This is consistent with opioid consumption and prescription reported in the literature, acknowledging that there is a wide range in prescribing and use patterns 16–18 . On the basis of a superiority design, attaining 80% power with α = .05, 152 participants (76 per group) were required to complete treatment and follow-up.…”

“…This is consistent with opioid consumption and prescription reported in the literature, acknowledging that there is a wide range in prescribing and use patterns. [16][17][18] On the basis of a superiority design, attaining 80% power with α = .05, 152 participants (76 per group) were required to complete treatment and follow-up. Assuming approximately 30% loss to follow-up, we planned to include up to 198 women (99 per group), with the plan to stop enrollment once the sample size was met.…”