Opioid Prescribing Practices for Women Undergoing Elective Gynecologic Surgery

Abstract

Study Objective To describe opioid prescribing practices in women undergoing elective gynecologic surgery for benign indications and determine the rate of new persistent opioid use (NPOU) among opioid-naïve women. Design Retrospective population-based cohort study using linked administrative data from a government administered single-payer healthcare system. Setting N/A Patients or Participants Adult women (≥18 years of age) who underwent elective gynecologic surgery between January 1st 2013 and March 31st 2018 for benign indications in Ontario, Canada. Women were included if they were opioid-naïve in the year prior to surgery. Interventions N/A Measurements and Main Results The primary outcome was peri-operative opioid use defined as ≥1 opioid prescription from 30 days before to 14 days after surgery. NPOU after gynecologic surgery was defined as having filled ≥1 opioid prescriptions between 91 days to 180 days post-operatively. Multivariable log-linear regression analyses were employed to adjust for clinical and demographic data. There were 132,506 patients included in our cohort. Perioperative opioid use was documented in 27,763 (21.0%) patients and NPOU was documented in 4,827 (3.65%) patients undergoing gynecologic surgery. Patients who filled an opioid prescription were significantly more likely to develop NPOU (unadjusted OR 1.49, 95%CI 1.40-1.59, p<0.0001). For every 65 patients with perioperative opioid use, 1 will develop NPOU. Patients were more likely to develop NPOU if they were healthier, had any mental health diagnosis, had substance/addiction disorder, or had a diagnosis of infertility. Patients in the highest quintiles of total prescribed oral morphine equivalents were also more likely to develop persistent opioid use. Conclusion Women undergoing gynecologic surgeries, irrelevant of level of invasiveness, are at increased of developing NPOU when filling an opioid prescription due to their surgery. Opioids play an important role in managing post-operative pain, however, the risks and benefits of prescribing them must be carefully weighed by healthcare providers. To describe opioid prescribing practices in women undergoing elective gynecologic surgery for benign indications and determine the rate of new persistent opioid use (NPOU) among opioid-naïve women. Retrospective population-based cohort study using linked administrative data from a government administered single-payer healthcare system. N/A Adult women (≥18 years of age) who underwent elective gynecologic surgery between January 1st 2013 and March 31st 2018 for benign indications in Ontario, Canada. Women were included if they were opioid-naïve in the year prior to surgery. N/A The primary outcome was peri-operative opioid use defined as ≥1 opioid prescription from 30 days before to 14 days after surgery. NPOU after gynecologic surgery was defined as having filled ≥1 opioid prescriptions between 91 days to 180 days post-operatively. Multivariable log-linear regression analyses were employed to adjust for clinical and demographic data. There were 132,506 patients included in our cohort. Perioperative opioid use was documented in 27,763 (21.0%) patients and NPOU was documented in 4,827 (3.65%) patients undergoing gynecologic surgery. Patients who filled an opioid prescription were significantly more likely to develop NPOU (unadjusted OR 1.49, 95%CI 1.40-1.59, p<0.0001). For every 65 patients with perioperative opioid use, 1 will develop NPOU. Patients were more likely to develop NPOU if they were healthier, had any mental health diagnosis, had substance/addiction disorder, or had a diagnosis of infertility. Patients in the highest quintiles of total prescribed oral morphine equivalents were also more likely to develop persistent opioid use. Women undergoing gynecologic surgeries, irrelevant of level of invasiveness, are at increased of developing NPOU when filling an opioid prescription due to their surgery. Opioids play an important role in managing post-operative pain, however, the risks and benefits of prescribing them must be carefully weighed by healthcare providers.