SUFU 2018: Opioid Prescription and Usage in Sacral Neuromodulation, Sling, and Prolapse Surgery: Are We Contributing to the Opioid Epidemic?
This was retrospective chart review at our institution was performed on all patients who underwent SNM, prolapse repair, and sling from June 2016 to May 2017. Patients were excluded if they were on chronic opioid therapy, or had a surgical complication causing increased pain. Patient characteristics as well as the amount of opioid prescribed to each patient after surgery were examined. A telephone survey was performed to identify the number of opioid pills used after surgery, patient satisfaction with pain control, and opioid disposal method. A multiple regression model was used to identify factors associated with variability in opioid usage.
The authors found that 123 patients met inclusion criteria. Patients were prescribed 20%, 135%, 150%, and 165% more morphine milligram equivalents (MME) than were used for autologous slings, prolapse, SNM, and midurethral slings respectively. The majority of patients were satisfied with their pain control. Of 75 patients with surplus pills, 22 (29%) disposed of them, and 5 (7%) did so properly. Disabled or unemployed patients used less MMEs (p=0.019), while those with diabetes (p=0.01), prior pelvic floor surgery (p=0.047), history of substance abuse (p=0.036), and rectocele repair (p=0.003) used more.
These data demonstrated over-prescription of opioids after SNM, prolapse repair, and sling and identifies potential factors associated with increased use of opioids. Current prescribing patterns are not evidence-based and can contribute to the epidemic of opioid abuse, diversion, and overdose. With this knowledge the authors recommended to guide physicians on appropriate opioid prescribing and decrease the contribution that urologists make to this growing public health problem.
Presented by: Dena Moskowitz MD, Virginia Mason Medical Center, Seattle, WA
Co Authors: Katherine Amin MD, Alvaro Lucioni MD, Kathleen Kobashi MD and Una Lee MD, Virginia Mason Medical Center, Seattle, WA
Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas