Perioperative Narcotic Trends in Women Undergoing Minimally Invasive Myomectomy.

ABSTRACT

STUDY OBJECTIVE: Evaluate the perioperative narcotic utilization patterns at the time of myomectomy, specifically as they relate to the opioid epidemic. We also aim to evaluate the differences between conventional laparoscopy and robotic surgery in terms of narcotic utilization. DESIGN: Retrospective cohort study. SETTING: Single academic university hospital. PATIENTS Women undergoing minimally invasive myomectomy. INTERVENTIONS: Laparoscopic or robot-assisted myomectomy. MEASUREMENTS AND MAIN RESULTS: We identified 312 minimally invasive myomectomies to be included in the final analysis. For the entire cohort, the mean age (± standard deviation) was 35.7 ± 5.1 years, and the mean body mass index was 28.3 ± 6.3. Of the 312 myomectomies included, 239 (76.6%) were performed using robotic assistance, and the remainder (23.4%) were performed by conventional laparoscopy. A statistically significant inverse relationship was found between year of myomectomy and perioperative narcotic administration (p <.001). Yearly morphine milligram equivalent (MME) administration decreased significantly for both intraoperative and postoperative administration (p <.001). The largest decline for intraoperative MME use was between 2016 and 2017, and for postoperative MME use, it was between 2012 and 2013. There was no statistically significant difference in perioperative narcotic administration between conventional laparoscopy and robot-assisted myomectomy. The time effect for intraoperative (p <.001) and postoperative (p <.001) narcotic administration remained significant after adjusting for covariates, including mode of surgery, race, insurance, age, and body mass index. None of the background variables assessed were associated with perioperative narcotic administration. CONCLUSION: Perioperative narcotic administration for minimally invasive myomectomy has decreased following widespread awareness of the national opioid crisis.