Intra-operative Factors Identified During Laparoscopy Hysterectomy are Correlated With Increased Post-operative Pain and Opioid Use

Abstract

Study Objective To identify intra-operative factors during laparoscopic hysterectomy associated with post-operative opioid use and pain scores Design Prospective cohort study of women undergoing laparoscopic hysterectomy. Primary outcome was the total amount of opioids utilized during the first 2 postoperative weeks. Secondary outcomes were the subjective pain score at 1 and 2 weeks after surgery. This is a secondary analysis of this dataset. Setting Two academic community teaching hospitals in the Boston metropolitan area Patients or Participants 125 women ages 30-76 undergoing hysterectomy for benign indications performed by minimally invasive gynecological surgeons Interventions All patients received a prescription for post-operative opioid medication. Surveys were administered at 1 week post-op and in-person at their two week postoperative visit and focused on pain scores (visual analog scale) and medication use (converted to morphine milligram equivalents (MME). Measurements and Main Results Participants were prescribed a median of 150 MME, however the median total opioid use was 37.5 MME (range 0-960 MMEs). Patients with pathology confirmed endometriosis required more than twice the total MME during the first 2 weeks compared to patients without endometriosis (mean 193 vs 95 MME, p =0.031). Patients with fibroids used significantly less total MME during the acute post-operative period compared to those without fibroids (mean 89.5 vs. 183.3 MMEs, p = 0.002) and reported significantly less pain at week 1 and 2 (p = 0.05). Adenomyosis, length of surgery, BMI, uterine weight and blood loss were not significantly correlated with total MME. Conclusion Several factors, easily recognized intra-operatively, may be predictive of opioid requirements during the acute post-operative period. This can allow surgeon to set expectations and dispense narcotic prescriptions that are patient specific. Individualizing prescriptions instead of merely writing standard amounts of opioids will lower the amount of excess circulating opioids and help combat the opioid epidemic. Further research is needed to validate this data in a larger population.