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Longitudinal patient-reported outcomes and restrictive opioid prescribing after minimally invasive gynecologic surgery
  1. R. Tyler Hillman1,
  2. Maria D Iniesta1,
  3. Qiuling Shi2,
  4. Tina Suki1,
  5. Tsun Chen2,
  6. Katherine Cain3,
  7. Loretta Williams2,
  8. Xin Shelley Wang2,
  9. Jolyn S Taylor1,
  10. Gabriel Mena4,
  11. Javier Lasala4,
  12. Pedro T Ramirez1 and
  13. Larissa A Meyer1
  1. 1 Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  4. 4 Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr R. Tyler Hillman, Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; rthillman{at}mdanderson.org; Dr Larissa A Meyer, Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; lmeyer{at}mdanderson.org

Abstract

Objective To determine post-discharge patient-reported symptoms before and after implementation of restrictive opioid prescribing among women undergoing minimally invasive gynecologic surgery.

Methods We compared clinical outcomes and symptom burden among a cohort of 389 women undergoing minimally invasive gynecologic surgery at a single institution before and after implementation of a restrictive opioid prescribing quality improvement initiative in July 2018. Post-discharge symptom burdens were collected up to 42 days after discharge using the MD Anderson Symptom Inventory and analyzed using linear mixed effects models.

Results The majority of women included in this study were white non-smokers and the median age was 55 (range 23–83). Most women underwent hysterectomy (64%), had surgery for malignancy (71%), and were discharged from the hospital on the day of surgery (65%). Women in the restrictive opioid prescribing group had a median reduction in morphine equivalent dose prescribed at discharge of 83%, corresponding to a median reduction in 25 tablets of 5 mg oxycodone per person. There was no difference between opioid prescribing groups in either the rate of refill requests (P=1) or hospital re-admission (P=1) up to 30 days after discharge. After adjustment for co-variates, there was no statistically significant difference in post-discharge symptom burden including patient-reported pain (P=0.08), sleep (P=0.30), walking interference (P=0.64), activity interference (P=0.12), or affective interference (P=0.67). There was a trend toward less reported constiptation in the restrictive opioid prescribing group that did not reach statistical significance (P=0.05).

Conclusion We found that restrictive post-operative opioid prescribing was not associated with differences in longitudinal symptom burden among women undergoing minimally invasive gynecologic surgery. These results provide the most comprehensive picture to date of post-operative symptom recovery under different opioid prescribing approaches, lending additional support for existing recommendations to reduce opioid prescribing following gynecologic surgery.

  • opioid-related disorders
  • pain
  • quality of life (PRO)/palliative care
  • surgery
  • postoperative care

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Footnotes

  • Twitter @RTylerHillmanMD, @TaylorJolyn, @gabemenaMD, @pedroramirezMD

  • Contributors RTH and LAM conceived of the initial experimental design and wrote the initial draft of the manuscript. RTH, MDI, QS, TS, TC, and KC collected and analyzed data. LW, XSW, JST, GM, JL, PTR, and LAM supervised the study and assisted with experimental design. All authors reviewed and revised the manuscript.

  • Funding RTH is a CPRIT Scholar in Cancer Research (RR200045). LAM is supported by a NIH-NCIK07-CA201013 grant. This work was in part supported through a NIH-NCI P30 CA016672 core grant (Biostatistics Resource Group and Clinical Trials Support Resource).

  • Competing interests LW reports grants from AstraZeneca, Astellas, Bayer, Bristol Meyers Squibb, Genentech, Eli Lily, and Merck, all outside of the submitted work. GM reports grants from Pacira Pharmaceuticals, outside of the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data and R code used for statistical analysis are available upon reasonable request.

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