Background: The opioid epidemic has been influenced in part by physician overprescribing. Several studies have evaluated opioid use after urogynecologic surgery, with limited data on postoperative guidelines. The objective of this study was to investigate the effect of implementing a multimodal, opioid-sparing analgesia regimen on opioid use, patient satisfaction, and refill rates.
Materials and methods: This was a retrospective observational study of female patients undergoing urogynecologic surgery at an academic center from 2017 to 2019, before and after introduction of an opioid-sparing multimodal regimen protocol advocating for standing ibuprofen and acetaminophen. Demographic information, opioid prescription details (oral morphine equivalent [OME]), and refill rate data were collected from the chart. Postoperative opioid use and satisfaction score (for the after group using Likert scale) was obtained by telephone survey. t Test was used to compare continuous variables, and χ2/Fischer exact test was used to compare categorical variables.
Results: Two hundred ninety-two patients were eligible and contacted. One hundred one patients responded before protocol implementation and 102 responded after protocol implementation. The median number of tablets prescribed was 14.5 (108.5 OME; IQR, 10) and 10 (75 OME; IQR, 5; P < 0.01) preprotocol and postprotocol, whereas the mean number of tablets used was 10 (75 OME; IQR, 13) and 3 (22.5 OME; IQR, 10; P = 0.0009) preprotocol and postprotocol, respectively. Refill rate did not differ significantly (11% preprotocol vs 7% postprotocol P = 0.32) Mean satisfaction score was 4.3 (SD, 0.9).
Conclusions: A multimodal analgesia regimen limiting postoperative opioids decreased postoperative opioid prescribing and consumption while maintaining similar patient satisfaction and refill rates.
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