Daily Dose: Persistent Opioid Use Post-Hysterectomy

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 18, 2023, we reported on a study published in the American Journal of Obestetrics and Gynecology that found that while the specific procedure route for benign hysterectomy was associated with the amount of perioperative opioids taken, that association did not predict which women would continue to use opioids from 3 months to 3 years after the procedure.

The study

The objective of this systematic literature review and meta-analysis was 2-pronged: to assess patterns of perioperative opioid dispensing for benign hysterectomy by procedure and to identify predictors of persistent use post-procedure.

The findings

Investigators found that perioperative opioids were dispensed to 83% of participants, with an average 143.5 morphine milligram equivalents dispensed per person (~19 5-mg oxycodone tablets). They found lower amounts dispensed for vaginal vs laparoscopic and abdominal procedures. The incidence of persistent use was calculated to be 5% but patient factors including age, alcohol use, smoking status, and chronic pain conditions rather than procedure route proved to be the significant predictors of long-term use.

Conclusion

To help optimize short- and long-term outcomes, study authors suggest drawing on recommendations from gynecologic oncologic societies “who advocate for setting patients’ expectations for postoperative pain, educating them on the drastic consequences of opioid misuse, and screening them for risk factors of long-term postoperative use, including past opioid use. “

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