Immediate Postoperative Opioid Use Patterns after Benign Hysterectomy

Background: Despite an increase in the performance of minimally invasive hysterectomy, opioid overprescribing postoperatively is common and can contribute to chronic long-term use. This study evaluated local/regional patterns of immediate opioid use after benign hysterectomy and identified quality gaps in physician prescribing practices. Methods: A retrospective chart review was conducted on all hysterectomies performed for benign indications at two tertiary care hospitals between January and December 2019. The primary outcome was opioid use in morphine milligram equivalents (MMEs) within the first 24 hours after surgery. Secondary outcomes were opioid prescribing patterns in different patient populations and length of hospital stay. A survey on opioid prescribing practices was conducted among gynecological providers. Results: A total of 669 patient records were reviewed between January and December 31, 2019. Median opioid use <24 hours following benign hysterectomy was 10 and 15MMEs, at respective sites. Nearly 30% of patients used no opioids postoperatively, 97% were opioid naïve. The presence of at least one postoperative pain diagnosis significantly increased opioid use from 10.9 MME to 22.5 MME ( p < 0.001). Postoperative opioid use was lower overall with a minimally invasive approach to hysterectomy ( p = 0.009 total MME). Gynecological attendings were more likely than trainees to evaluate for risks of opioid dependency before prescribing. Conclusion: Patients undergoing hysterectomy for benign indications used minimal to no opioids in the immediate in-hospital postoperative period. Future directions are needed to investigate the role for integrated perioperative risk assessments to guide opioid prescribing.