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. 2023 Apr 1;141(4):681-696.
doi: 10.1097/AOG.0000000000005104. Epub 2023 Mar 9.

Prescription Opioid Use for Acute Pain and Persistent Opioid Use After Gynecologic Surgery: A Systematic Review

Kristen A Matteson  1 , Megan O Schimpf, Peter C Jeppson, Jennifer C Thompson, Rajiv B Gala, Sunil Balgobin, Ankita Gupta, Deslyn Hobson, Cedric Olivera, Ruchira Singh, Amanda B White, Ethan M Balk, Kate V Meriwether; Society of Gynecologic Surgeons Systematic Review Group
Affiliations

Prescription Opioid Use for Acute Pain and Persistent Opioid Use After Gynecologic Surgery: A Systematic Review

Kristen A Matteson et al. Obstet Gynecol. .

Abstract

Objective: To assess the amount of opioid medication used by patients and the prevalence of persistent opioid use after discharge for gynecologic surgery for benign indications.

Data sources: We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from inception to October 2020.

Methods of study selection: Studies with data on gynecologic surgical procedures for benign indications and the amount of outpatient opioids consumed, or the incidence of either persistent opioid use or opioid-use disorder postsurgery were included. Two reviewers independently screened citations and extracted data from eligible studies.

Tabulation, integration, and results: Thirty-six studies (37 articles) met inclusion criteria. Data were extracted from 35 studies; 23 studies included data on opioids consumed after hospital discharge, and 12 studies included data on persistent opioid use after gynecologic surgery. Average morphine milligram equivalents (MME) used in the 14 days after discharge were 54.0 (95% CI 39.9-68.0, seven tablets of 5-mg oxycodone) across all gynecologic surgery types, 35.0 (95% CI 0-75.12, 4.5 tablets of 5-mg oxycodone) after a vaginal hysterectomy, 59.5 (95% CI 44.4-74.6, eight tablets of 5-mg oxycodone) after laparoscopic hysterectomy, and 108.1 (95% CI 80.5-135.8, 14.5 tablets of 5-mg oxycodone) after abdominal hysterectomy. Patients used 22.4 MME (95% CI 12.4-32.3, three tablets of 5-mg oxycodone) within 24 hours of discharge after laparoscopic procedures without hysterectomy and 79.8 MME (95% CI 37.1-122.6, 10.5 tablets of 5-mg oxycodone) from discharge to 7 or 14 days postdischarge after surgery for prolapse. Persistent opioid use occurred in about 4.4% of patients after gynecologic surgery, but this outcome had high heterogeneity due to variation in populations and definitions of the outcome.

Conclusion: On average, patients use the equivalent of 15 or fewer 5-mg oxycodone tablets (or equivalent) in the 2 weeks after discharge after major gynecologic surgery for benign indications. Persistent opioid use occurred in 4.4% of patients who underwent gynecologic surgery for benign indications. Our findings could help surgeons minimize overprescribing and reduce medication diversion or misuse.

Systematic review registration: PROSPERO, CRD42020146120.

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Conflict of interest statement

Financial Disclosure Kristen A. Matteson is an advisor for Myovant and a nonpaid researcher for Bayer; Megan O. Schimpf receives an editorial stipend from Wolters-Kluwer and receives a reviewer stipend for UpToDate; Peter C. Jeppson is a product liability consultant for Ethicon; Amanda B. White is a consultant for Boston Scientific; Kate V. Meriwether is a consultant for RBI Medical, receives book royalties from Elsevier Publishing, is research chair for the Society of Gynecologic Surgeons, is a board member of Society of Gynecologic Surgeons, isa nonpaid researcher for Cook MyoSure and Caldera Medical. The other authors did not report any potential conflicts of interest.

References

    1. As-Sanie S, Till SR, Mowers EL, Lim CS, Skinner BD, Fritsch L, et al. Opioid prescribing patterns, patient use, and postoperative pain after hysterectomy for benign indications. Obstet Gynecol 2017;130:1261–8. doi: 10.1097/AOG.0000000000002344 - DOI
    1. OPEN: Opioid Prescribing Engagement Network. OPEN prescribing recommendations. Accessed July 17, 2022. https://opioidprescribing.info/
    1. Kennedy-Hendricks A, Gielen A, McDonald E, McGinty EE, Shields W, Barry CL. Medication sharing, storage, and disposal practices for opioid medications among US adults. JAMA Intern Med 2016;176:1027–9. doi: 10.1001/jamainternmed.2016.2543 - DOI
    1. Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol 2011;185:551–5. doi: 10.1016/j.juro.2010.09.088 - DOI
    1. Chapman T, Kim N, Maltenfort M, Ilyas AM. Prospective evaluation of opioid consumption following carpal tunnel release surgery. Hand 2017;12:39–42. doi: 10.1177/1558944716646765 - DOI

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