Opioid Prescription and Use in Sacral Neuromodulation, Mid Urethral Sling and Pelvic Organ Prolapse Surgery: An Educational Intervention to Avoid Over Prescribing.

ABSTRACT

PURPOSE: The opioid problem has reached epidemic proportions and the prescription of opioids after surgery can lead to chronic use. We explored prescribing patterns and opioid use after 3 pelvic floor surgeries (sacral neuromodulation, prolapse repair and mid urethral sling) before and after an educational intervention to reduce opioid prescriptions. MATERIALS AND METHODS: We retrospectively reviewed the amount of opioid medication prescribed to patients who underwent these 3 types of surgeries at our institution from June 2016 to May 2017. A telephone survey of patients was done to quantify opioid use after surgery and satisfaction with pain control. Prescribing recommendations were established based on these results and an educational intervention for clinicians was performed. We then evaluated changes in opioid prescription and use during the 6 months following the intervention. A multiple regression model was used to identify factors associated with variability in opioid use. RESULTS: Our retrospective review showed that the 122 patients were prescribed 149%, 165% and 136% more mean morphine mg equivalents than were actually used for sacral neuromodulation, mid urethral sling and prolapse repair, respectively. After the educational intervention there was a significant reduction in morphine mg equivalents prescribed for all 3 surgeries in 78 patients (p <0.001). Diabetes (p = 0.001), a chronic pain condition (p = 0.017) and rectocele repair (p = 0.001) were associated with increased opioid use. CONCLUSIONS: Our data demonstrate that over prescription of opioids after pelvic floor surgery and a provider educational intervention resulted in a significant reduction in opioid prescribing without changing patient satisfaction with pain control.