Developing a patient-centered opioid prescribing model: A prospective evaluation of opioid prescribing and utilization patterns among gynecologic oncology patients (581)

Abstract

<b>Objectives:</b> The opioid epidemic is recognized as a public health crisis. Overprescribing opioids for postoperative pain management is commonly reported in surgical specialties, yet prescription guidelines are not well described after gynecologic oncology surgery. We sought to describe opioid prescribing and utilization patterns in gynecologic oncology patients to inform the development of a patient-centered opioid prescribing algorithm. <b>Methods:</b> This prospective cohort study recruited opioid naïve, gynecologic oncology patients undergoing hysterectomy. Demographic data, surgical data, inpatient opioid use, validated PROMIS pain inference questionnaires, and satisfaction surveys were collected. Medication diaries were collected at the 2- and 6-week postoperative visits. Outpatient postoperative opioid use was collected and converted to oral morphine milligram equivalents (MME). A retrospective chart view was completed to abstract details of the operation and the patient's inpatient opioid requirement. Descriptive statistics were used to quantify opioid prescribing and utilization patterns in MME. Wilcoxon rank-sum tests were used to compare opioid requirements by the surgical route. Nonparametric statistical methods were used to identify factors associated with outpatient narcotic use. An algorithm for future opioid prescribing was developed using the 95^th percentile of outpatient opioid use. <b>Results:</b> From January 2021 to July 2021, 65 women were recruited, with 57 completing follow-up data collection. The surgical approach was divided evenly with 49% open and 51% minimally invasive groups (MIS). The amounts of outpatient opioid prescription and use were lower in the MIS group compared to the open surgery group (p 0.011 and p 0.045, respectively). In the MIS group, the median prescribed opioids were 38 MME (IQR: 20-75 MME), equivalent to five pills of 5mg Oxycodone while median usage was 4 MME (IQR: 0-22), equivalent to one pill of 5mg Oxycodone. For the open group, 96 MME was prescribed (IQR: 38-150), equivalent to 20 pills, while usage was 31 MME (IQR: 0-82), equivalent to five pills. Twenty-four patients (42%) did not use any narcotics. Factors that correlated with postoperative opioid use included surgical procedure, estimated blood loss, the amount of narcotic taken during the last 24 hours as an inpatient, tobacco use, and patient's BMI. Patient reported high satisfaction with their preoperative teaching specific to pain control. Finally, 84% of patients had pain ratings on the PROMIS survey within normal limits at 6-week compared to a referent population. <b>Conclusions:</b> In this cohort, opioids were overprescribed for all patients, necessitating the need for more restrictive, personalized prescribing practices. As described in Figure 1, surgical route and last 24 hours inpatient MME can help delineate patient's opioid requirements and aid in the development of patient-centered guidelines for opioid prescribing in the postoperative period. Fig. 1