An Analysis of Opioid Consumption and Patient Recovery after Hysterectomy by Surgical Approach

<b><i>Background:</i></b> Minimally invasive hysterectomy is preferred to open hysterectomy due to lower morbidity, but recent data regarding the association of surgical approach with patient recovery and opioid consumption are lacking. <b><i>Objective:</i></b> To analyze how postoperative opioid use and return to baseline activity vary by surgical approach for hysterectomy. <b><i>Study design:</i></b> This was a retrospective cohort study including hysterectomy patients from the Michigan Surgical Quality Collaborative registry that was linked to the State of Michigan's prescription drug monitoring program. We analyzed two primary outcomes with respect to surgical approach: opioid consumption in the 30 days following surgery, measured in morphine milligram equivalents (MMEs), and return to baseline activity >4 weeks after surgery. Adjusting for demographics, comorbidities, preoperative opioid use, surgical indication, clinical events at 30 days postoperatively, and surgical approach, we used multivariable linear regression and logistic regression models to identify factors associated with our primary outcomes. <b><i>Results:</i></b> Lower opioid consumption was reported with minimally invasive hysterectomy, with mean postoperative opioid consumption (95% CI) of 32.70 (27.15-38.26) MMEs for vaginal, 39.91 (37.17-42.65) MMEs for laparoscopic, and 54.97 (48.81-61.13) MMEs for open hysterectomy. Other covariates associated with lower opioid consumption included older age and year of surgery in 2019 versus 2018. Predicted probability of return to baseline activities >4 weeks after surgery was 51% (44-57%), 43% (40-45%), and 64% (60-69%) for vaginal, laparoscopic, and open hysterectomy, respectively. <b><i>Conclusion:</i></b> Minimally invasive approaches to hysterectomy are associated with lower postoperative opioid consumption and a more rapid recovery relative to open hysterectomy.