Perioperative opioid filling for midurethral sling

A study in the journal Female Pelvic Medicine & Reconstructive Surgery has concluded that patients undergoing isolated midurethral sling placement filled a median of 150 cumulative morphine milligram equivalents (MMEs) from 28 days before surgery to 28 days after surgery.¹

Patients were identified in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, from which the investigators determined whether sling placement was an isolated procedure or performed in conjunction with other benign gynecologic procedures.

All outpatient prescription drug claims for opioids were recorded from 28 days before surgery to 28 days after surgery. The investigators then flagged the number of prescriptions filled and calculated MMEs in the allotted perioperative window.

The study cohort comprised 153,631 patients, of whom 51.5% underwent an isolated procedure, and the remaining 48.5% multiple benign procedures.

Overall, 72% of the patients who had isolated midurethral sling placement received at least 1 opioid prescription in the allocated perioperative window compared with 79% of those undergoing combined procedures (P < 0.001).

The median cumulative MMEs for isolated midurethral sling and midurethral sling + multiple procedures were 150 MMEs and 225 MMEs, respectively (P < 0.001).

For the entire study period, the number of prescription opioid claims was 161,471, with hydrocodone (54.4%) and oxycodone (31.8%) representing most (86.2%) of the prescription drug claims.

In addition, 81.9% of all prescriptions included combination narcotics, with 53.0% acetaminophen/hydrocodone and 28.9% acetaminophen/oxycodone.

Among patients undergoing isolated midurethral sling placement, 15.1% filled an opioid prescription during the 28-day presurgical period vs. 19.7% of patients who underwent multiple procedures (P < 0.001).

Also, presurgically, patients undergoing an isolated sling procedure received a median of 200 MMEs, whereas patients undergoing multiple procedures received a median of 225 MMEs (P < 0.001).

Postsurgically, though, the percentage of patients who filled an opioid prescription rose dramatically: 64.6% of patients undergoing isolated sling placement vs. 69.2% of patients who underwent multiple procedures (P < 0.001).

Patients undergoing isolated sling placement received a median of 150 MMEs in the postsurgical period, whereas patients undergoing multiple procedures received 225 MMEs (P < 0.001).

“Interestingly, this study revealed that among both isolated and multiple surgery patients who had filled a prescription for an opioid in the 28 days before surgery, approximately half-filled at least one additional prescription in the postsurgical period,” wrote the authors. “Although we acknowledge that this pattern could be secondary to chronic opioid use among some of the study population, it raises the question of possible duplicative or excess prescribing.”

For the total study period, every 1-year increase in the year of surgery was associated with 11% higher odds of filling an opioid prescription: odds ratio (OR) 1.11; 95% confidence interval (CI): 1.10 to 1.12 (P < 0.001.

Compared to isolated procedures, multiple procedures had 36% higher odds of filling an opioid prescription during the entire study period: OR 1.36; 95% CI: 1.33 to 1.39; P < 0.001). But for the whole study period, there was no significant change in median cumulative MME over time.

There is a continuing need for information on evidence-based use of opioids, given the highly variable prescribing patterns for the drugs, according to the authors. It is hoped that future studies can be done to identify parameters for optimal use of opioids after midurethral sling placement.

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Reference

1. Feroz RT, Boyd SS, Schaefer EW, Swailes AL, Long JB. Postoperative opioid filling patterns in women undergoing midurethral sling placement. Female Pelvic Med Reconstr Surg. Published online September 4, 2020. doi:10.1097/SPV.0000000000000919