13: Postoperative narcotic utilization in older women after pelvic organ prolapse surgery

Abstract

To quantify narcotic utilization (total consumption) by older women during the first week after pelvic organ prolapse (POP) surgery. This is an interim, ancillary analysis of a prospective cohort study assessing changes in cognition in women ≥60 years undergoing POP surgery on an academic urogynecology service. Exclusion criteria include diagnosis of cognitive impairment, history of stroke or chronic neurologic condition, use of antipsychotic medication, or Modified Mini-Mental State Examination score of less than 84. Baseline sociodemographic, medical history, intraoperative and postoperative variables, and adverse events through 6 weeks postoperatively were abstracted from the electronic medical record (EMR). Women were asked to complete diaries recording daily narcotic use from hospital discharge through postoperative day (POD) #7. To quantify narcotic use, total narcotic consumption was calculated including any narcotic administration inpatient after surgery and home narcotic use after discharge. Narcotic use was standardized to morphine milligram equivalents (MMEs) and analyzed using summary statistics. Chi-squared (Fisher’s exact) tests and Student’s T (Mann U Whitney) tests were used to analyze categorical and continuous variables. Regression models were created to assess the association between clinical factors and home narcotic use. Analyses were conducted on narcotic use data provided by 85 of 105 enrolled women. Mean age was 71.9±5.9 years (range 60-88). The majority were white (95.3%, n=81). 69.4% (n=59) underwent vaginal surgery and 30.6% (n=26) underwent laparoscopic/robotic surgery, with concomitant hysterectomy in 59.3% (n=51). Mean operative time was 2.43±0.86 hours. 84.9% (n=73) were discharged the day of surgery. 65.5% (n=55) received MS Contin (15 mg) prior to the start of the procedure. 32.9% (n=28) reported no use of home narcotics. Median (IQR) MMEs after surgery was 5.63 (0-13.35) on POD0 and 7.5 (0-15) on POD1. Median MMEs was 0 POD 2-7. The median total MMEs used during the first week after surgery is 28.9 (6.4–65). Most women were prescribed 30 narcotic tablets on discharge. 6 women did not fill narcotic prescription. Regression statistics found there weren’t any factors that were significantly associated with home narcotic use. Variables included in multivariable models included frailty exhaustion score (p=0.16), Beck anxiety inventory score (p=0.19), general anesthesia (p=0.09), intraoperative fentanyl (p=0.13), phenylephrine use (p=0.08) and intraoperative hydromorphone use (p=0.06), and estimated blood loss (p=0.14). In the final model, none of the variables were significantly associated with home narcotic use. Narcotic consumption after POP surgery in older women is modest and equates to 4 (1-9) 5 mg oxycodone tablets generally taken within the first 48 hours of surgery.