Introduction: To assess longitudinal prescribing patterns for patients undergoing surgery for pelvic organ prolapse in the 2-year timeframe before and after implementing an evidence based opioid prescribing recommendation and evaluate the impact of these recommendations on institutional practices.
Methods: Prospective data was previously used to create a 3-tiered recommendation for opioid prescribing following pelvic organ prolapse surgery at our institution based on narcotic use postoperatively. The guideline was implemented December 2017. Prescribing patterns including the quantity of opioids prescribed (in oral morphine equivalents [OMEs]) and refill rates were compared for opioid naïve patients undergoing prolapse surgery before (November 2015 through November 2017; N=238) and after (December 2017-December 2019; N=361) guideline implementation. Univariate analysis was performed using Wilcoxon rank sum and chi-squared tests. Cochran- Armitage trend tests and interrupted time series analysis were used to test for significance in the change in OMEs prescribed before vs after guideline implementation.
Results: The quantity of opioids prescribed at hospital discharge decreased from a median 225 OMEs (Interquartile range [IQR] 225, 300) before the guideline to 0 OMEs (IQR 0,75) after guideline implementation overall (p=xx) and also within each individual subgroup of prolapse surgery: native tissue vaginal (p < 0.0001), robotic sacrocolpopexy (p < 0.0001), open sacrocolpopexy (p < 0.0001), and colpocleisis (p < 0.003). The overall proportion of patients discharged following prolapse surgery without opioids significantly increased after guideline implementation (49.9% after vs 4.2% before; p<0.0001). Despite the significant decrease in opioid prescribing, rate of opioid refills was similar before (2.9%) versus after (6.5%) guideline implementation (p=0.06).
Conclusions: With two years of postimplementation follow up, the use of procedure-specific, tiered opioid prescribing guidelines at our institution was associated with a significant reduction in opioids prescribed without adversely impacting refill rates. This study further supports the use of evidence-based guidelines for opioid prescribing.