Abstract
Most women are prescribed an opioid after hysterectomy. The goal of this study was to determine the association between initial opioid prescribing characteristics and chronic opioid use after hysterectomy. This study included women enrolled in a commercial health plan who had a hysterectomy between 1 July 2010 and 31 March 2015. We used trajectory models to define chronic opioid use as patients with the highest probability of having an opioid prescription filled during the 6 months post-surgery. A multivariable logistic regression was applied to examine the association between initial opioid dispensing (amount prescribed and duration of treatment) and chronic opioid use after adjusting for potential confounders. A total of 693 of 50 127 (1.38%) opioid-naïve women met the criteria for chronic opioid use following hysterectomy. The baseline variables and initial opioid prescription characteristics predicted the pattern of long-term opioid use with moderate discrimination (c statistic = 0.70). Significant predictors of chronic opioid use included initial opioid daily dose (≥60 MME vs <40 MME, aOR: 1.43, 95% CI: 1.14-1.79) and days' supply (4-7 days vs 1-3 days, aOR: 1.28, 95% CI: 1.06-1.54; ≥8 days vs 1-3 days, aOR: 1.41, 95% CI: 1.05-1.89). Other significant baseline predictors included older age, abdominal or laparoscopic/robotic hysterectomy, tobacco use, psychiatric medication use, back pain, and headache. Initial opioid prescribing characteristics are associated with the risk of chronic opioid use after hysterectomy. Prescribing lower daily doses and shorter days' supply of opioids to women after hysterectomy may result in lower risk of chronic opioid use.
Highlights
The rapid increase in the incidence of opioid-related overdoses and deaths has become8 a major public health crisis in the United States
A total of 693 of 50,127 (1.38%) opioid naïve women met the criteria for chronic opioid use following hysterectomy
Among the patients in trajectory 4 (n=693, 1.38%), 57%, 55%, 57%, 55%, 48%, and 41% filled an opioid prescription at 1 month, 2 months, 3 months, 4 months, 5 months, and 6 months following an initial prescription in the 7 days post-hysterectomy, respectively
Summary
The rapid increase in the incidence of opioid-related overdoses and deaths has become8 a major public health crisis in the United States. Hysterectomy, the most commonly performed non-obstetric surgery among women in the United States,[19,20,21] poses a potential risk for chronic opioid use because an estimated 82% of patients receive an opioid prescription after the hysterectomy surgery.[20,22] the relationship between the initial opioid prescribing characteristics and chronic opioid use after hysterectomy remains largely unknown. The objective of this study was to identify baseline risk factors for chronic opioid use after hysterectomy and examine the association between initial opioid prescribing characteristics after hysterectomy and subsequent chronic use of opioids among opioid naïve women. The objective of this study was to determine the association between initial opioid prescribing characteristics and chronic opioid use after hysterectomy.
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