• Insiyyah Patanwala, Chensi Ouyang, Matthew Fisk, and Georgine Lamvu.
• Department of Obstetrics and Gynecology (Drs. Patanwala, Ouyang, and Fisk), Florida Hospital, Orlando, Florida; Department of Obstetrics and Gynecology (Dr. Patanwala), Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: ipatanwa@iu.edu.
• J Minim Invasive Gynecol. 2020 May 1; 27 (4): 860-867.

Study ObjectiveTo compare the amount of opioids (tablets and morphine milligram equivalents [MMEs]) prescribed by physicians and used by patients after benign gynecologic surgery.DesignProspective cohort study.SettingTertiary center: main hospital operating room and outpatient surgery center.PatientsWomen undergoing benign gynecologic surgery.InterventionsMajor and minor gynecologic surgeries.Measurements And Main ResultsThe surgery groups were minor laparoscopy (Minor), major minimally invasive (Major), and laparotomy (Laparotomy). Demographic, medical, and surgical data were abstracted from electronic medical records. On postoperative day (POD) 7, women completed a telephone survey describing pain levels, prescription use, and satisfaction with pain control. Patients who continued to use opioids for pain relief were surveyed on POD 14. If use continued, patients were surveyed again on POD 28. The primary outcome was amount of opioid prescribed compared with opioid used. Of 193 screened participants 172 were enrolled (89%), and data were analyzed for 154 (90%): 59 (38%) Major, 71 (56%) Minor, and 24 (16%) Laparotomy. The median number of tablets and MMEs prescribed was lowest for the Minor group (Minor, 24 tablets; Major, 30 tablets; Laparotomy, 30 tablets [p <.01]; Minor, 150 MMEs; Major, 225 MMEs; Laparotomy, 225 MMEs [p = .01]). We found no difference in the number of tablets (Minor, 8; Major, 8; Laparotomy, 9; p = .77) or MMEs used (Minor, 45 MMEs; Major, 45 MMEs; Laparotomy, 55 MME; p = .81) between the groups. On POD 7 there was no difference in median numerical rating scale pain scores (Minor, 3; Major, 2; Laparotomy, 2; p = .07) or satisfaction with analgesia on POD 7 (p = .44), 14 (p = .87), and 28 (p = .18). Patients with prior chronic pain used more total amounts of opioids (68 MME vs 30 MME, p <.01) and were more likely to require opioid refill (odds ratio, 10.4; 95% confidence interval, 1.3-83.6) compared with those without a similar history.ConclusionIn this cohort, gynecologic surgeons prescribed nearly 3 times more opioid tablets and MMEs than was used by patients despite patients reporting similar levels of pain after minor and major surgeries.Copyright © 2019 AAGL. All rights reserved.

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