Postoperative Narcotic Use After Ambulatory Gynecologic Surgery

Abstract

Objective:

This article describes the average number of narcotics used after common ambulatory gynecologic surgeries and describes provider prescribing patterns.

Materials and Methods:

This was a prospective observational cross-sectional study in patients undergoing benign gynecologic surgery. Patients were identified via the gynecologic surgery schedule from a Midwestern urban academic hospital and enrolled from 8/2018 to 7/2019. Each patient was recruited preoperatively, signed consent, and completed a baseline pain and demographic survey. Inclusion criteria were patients ages 18–99; English-speaking; and undergoing benign gynecologic ambulatory surgery, such as benign laparoscopic adnexal surgery, midurethral sling placement, and/or anterior or posterior repair. Patients were excluded if they had past or current cancer diagnoses, chronically used narcotics, had chronic pain currently being treated by physicians, had surgeries converted into laparotomies, or were admitted to the hospital postoperatively for pain control. After enrollment, patients completed diaries to record narcotic use and postoperative pain for 7 days postoperatively. These patients were then contacted to provide information regarding amounts of narcotic medications used as well as additional medications used for pain. Descriptive statistics, Spearman-rank correlations, and Kruskal–Wallis tests were used.

Results:

Ninety subjects were enrolled and 75 completed follow-ups. Subjects on average were prescribed 14.3 tablets of narcotics (most often 5/325 of NORCO,^® 50 mg of tramadol, or 300/30 mg of Tylenol^® #3) correlating to 70.6 morphine mg equivalents (MMEs). Subjects on average used 3.9 tablets correlating to 19.5 MMEs, with 75% of patients using 6 tablets or less within 7 days after surgery. After ambulatory benign gynecologic surgery, patients had an average excess of 10.4 unused prescribed narcotic tablets (or 71% of prescribed pills). Age, patient history of depression, baseline pain medication use, and number of narcotics prescribed were associated with increased postoperative narcotic use.

Conclusions:

Gynecologic surgeons prescribe narcotics in excess of patients' needs.