TY - JOUR
T1 - Opioid Prescription and Use in Sacral Neuromodulation, Mid Urethral Sling and Pelvic Organ Prolapse Surgery
T2 - An Educational Intervention to Avoid over Prescribing
AU - Moskowitz, Dena
AU - Amin, Katherine
AU - Lucioni, Alvaro
AU - Kobashi, Kathleen
AU - Lee, Una
N1 - Publisher Copyright:
© 2019 by American Urological Association Education and Research, Inc.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Purpose:The opioid problem has reached epidemic proportions and the prescription of opioids after surgery can lead to chronic use. We explored prescribing patterns and opioid use after 3 pelvic floor surgeries (sacral neuromodulation, prolapse repair and mid urethral sling) before and after an educational intervention to reduce opioid prescriptions.Materials and Methods:We retrospectively reviewed the amount of opioid medication prescribed to patients who underwent these 3 types of surgeries at our institution from June 2016 to May 2017. A telephone survey of patients was done to quantify opioid use after surgery and satisfaction with pain control. Prescribing recommendations were established based on these results and an educational intervention for clinicians was performed. We then evaluated changes in opioid prescription and use during the 6 months following the intervention. A multiple regression model was used to identify factors associated with variability in opioid use.Results:Our retrospective review showed that the 122 patients were prescribed 149%, 165% and 136% more mean morphine mg equivalents than were actually used for sacral neuromodulation, mid urethral sling and prolapse repair, respectively. After the educational intervention there was a significant reduction in morphine mg equivalents prescribed for all 3 surgeries in 78 patients (p <0.001). Diabetes (p = 0.001), a chronic pain condition (p = 0.017) and rectocele repair (p = 0.001) were associated with increased opioid use.Conclusions:Our data demonstrate that over prescription of opioids after pelvic floor surgery and a provider educational intervention resulted in a significant reduction in opioid prescribing without changing patient satisfaction with pain control.
AB - Purpose:The opioid problem has reached epidemic proportions and the prescription of opioids after surgery can lead to chronic use. We explored prescribing patterns and opioid use after 3 pelvic floor surgeries (sacral neuromodulation, prolapse repair and mid urethral sling) before and after an educational intervention to reduce opioid prescriptions.Materials and Methods:We retrospectively reviewed the amount of opioid medication prescribed to patients who underwent these 3 types of surgeries at our institution from June 2016 to May 2017. A telephone survey of patients was done to quantify opioid use after surgery and satisfaction with pain control. Prescribing recommendations were established based on these results and an educational intervention for clinicians was performed. We then evaluated changes in opioid prescription and use during the 6 months following the intervention. A multiple regression model was used to identify factors associated with variability in opioid use.Results:Our retrospective review showed that the 122 patients were prescribed 149%, 165% and 136% more mean morphine mg equivalents than were actually used for sacral neuromodulation, mid urethral sling and prolapse repair, respectively. After the educational intervention there was a significant reduction in morphine mg equivalents prescribed for all 3 surgeries in 78 patients (p <0.001). Diabetes (p = 0.001), a chronic pain condition (p = 0.017) and rectocele repair (p = 0.001) were associated with increased opioid use.Conclusions:Our data demonstrate that over prescription of opioids after pelvic floor surgery and a provider educational intervention resulted in a significant reduction in opioid prescribing without changing patient satisfaction with pain control.
KW - opioid-related disorders
KW - pelvic organ prolapse
KW - suburethral slings
KW - transcutaneous electric nerve stimulation
KW - urethra
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U2 - 10.1097/JU.0000000000000028
DO - 10.1097/JU.0000000000000028
M3 - Article
C2 - 30676474
AN - SCOPUS:85065097610
SN - 0022-5347
VL - 201
SP - 979
EP - 986
JO - Journal of Urology
JF - Journal of Urology
IS - 5
ER -