01: Randomized controlled trial assessing the effect of patient education on postoperative opioid consumption after prolapse surgery

Abstract

The aim of the study was to determine whether providing specialized perioperative counseling decreases opioid consumption within 2 weeks following pelvic organ prolapse (POP) surgery. This was a randomized, controlled, study of women undergoing POP surgery at a large academic medical center and community HMO. Subjects were randomized to either standard or specialized counseling; the latter included educational handouts with FDA recommendations regarding opioid consumption, storage, and disposal methods. Subjects in both groups were prescribed a standard analgesic regimen including ibuprofen, acetaminophen, and 150 oral morphine equivalents (OME) of oxycodone. The primary outcome was postoperative OME consumption. Secondary outcomes included pain scores, additional postoperative opioid prescriptions, patient satisfaction, and opioid storage/disposal patterns. An a priori sample size calculation demonstrated that 63 subjects were required in each group to detect a consumption difference of 37.5mg OME (∼ 5 tablets of oxycodone) between groups with an alpha of 0.05 and 80% power. One hundred thirty-five subjects were included in the final analysis (65 standard and 70 specialized counseling). There were no significant demographic differences between subjects in the two groups. Subjects in the educational group were more likely to have a concomitant perineorrhaphy (61.4% vs. 40%, p=0.01), but otherwise there were no significant differences between the 2 groups in type and duration of surgery, concomitant anti-incontinence procedures, perioperative complications, or length of postoperative hospitalization (all p>0.05). Subjects in the standard and specialized counseling groups consumed similar quantities of OME, both during the postoperative hospitalization (32.5 mg vs. 35.9 mg) and 2 weeks postoperatively (38.5 mg vs. 61.8 mg). The overall median OME consumed at 2 weeks after surgery was 15 mg (IQR 0,75), which is the equivalent of 2 tablets of oxycodone 5 mg. Fifty-four subjects (40%) did not consume any opioids post discharge. Subjects in both groups were found to have similar opioid storage/disposal patterns, opioid refill rates, satisfaction with the prescription, and pain scores (all p > 0.05). Subjects whose OME consumption were in the top quartile (≥75 mg) were more likely to be younger and have a history of depression, anxiety or chronic pain. They were also more likely to have a preexisting opioid prescription, consume more OME during the postoperative hospitalization, and have an opioid refill within 2 weeks (all p < 0.05). Specialized perioperative counseling did not affect postoperative opioid consumption, storage, or disposal after POP surgery. Forty percent of subjects did not consume opioids after hospital discharge. Postoperative opioid consumption was low with acceptable pain scores, which could help inform future prescribing patterns.