Abstract
<b>Objectives:</b> As surgeons, it is our ethical imperative to minimize the harmful impact on patients and their communities through the prescription of perioperative opioid medication. This study reviews the perioperative opioid use in our gynecologic oncology surgical practice over the last decade. <b>Methods:</b> We undertook a chart review of adult gynecologic oncology patients who underwent open surgery from July 1, 2012, to August 26, 2021. Perioperative and patient characteristics were abstracted. Prospective phone surveys were completed from April through September 2021 in this patient population two to four weeks after surgery to assess self-reported opioid use post-hospital discharge. Quantities of oral and intravenous opioid medications are reported as oral morphine equivalents (OME). Data are presented as proportions or median results by year and compared using Chi-square tests or Wilcoxon rank-sum tests, respectively. <b>Results:</b> There were 1210 patients included in the chart review, and we completed 75 prospective surveys. From 2012 to 2021, the rate of non-steroidal anti-inflammatory drug use increased from 40.7% to 80% (p<0.01), and the use of epidurals and transversus abdominis plane (TAP) blocks increased from 46.5% to 93.9% (p<0.01, Figure 1a). The median length of hospital stay was decreased by 20% (5 to 4 days, p<0.01). The total amount of OME used per patient in the hospital decreased by 62.6% from 2012 to 2021 (412 OME in 2012 vs 154.3 OME in 2021, p<0.01). When divided by length of stay, the median OME used per day also decreased (84.7 OME in 2012 vs 42 OME in 2021, p<0.01). Opioid prescription sizes at the time of hospital discharge significantly decreased as well from 675 OME per patient in 2012 (equivalent to 90 doses of 5mg oxycodone tablets) to 150 OME per patient in 2021 (equivalent to 20 doses of 5mg oxycodone tablets, p<0.01, Figure 1b). From our prospective survey data, the actual amount of OME used by patients in 2021 after hospital discharge was a median of 22.5 OME (equivalent to 3 doses of 5mg oxycodone tablets per patient). There was a decrease in preoperative opioid use from 2012 to 2021 (41.9% in 2012 vs 28.7% in 2021, p=0.05). The refill rate for postoperative opioids did not significantly differ during this time period (18% in 2012 vs 10.4% in 2021, p=0.10). <b>Conclusions:</b> Patients in this study used fewer opioids in the perioperative period between 2012 and 2021, likely due to utilization of enhanced recovery after surgery pathways and increased awareness of the risks of opioid misuse. While our division reduced the median postoperative opioid prescription size from 2012 to 2021 by 77.7%, our findings suggest we could further reduce prescription sizes by an additional 85% and still adequately treat our patients' postoperative pain. Ongoing assessment of surgical patients' opioid medication needs and patterns of prescribing is essential for addressing our contributions to the opioid epidemic.
Published Version
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