From the Division of Urogynecology, University of Pittsburgh Medical Center.
Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh PA.
Female Pelvic Med Reconstr Surg. 2021 Mar 1;27(3):175-180. doi: 10.1097/SPV.0000000000001010.
The purpose of this analysis is to determine if postoperative opioid usage differs among women randomized to office or phone preoperative counseling for pelvic organ prolapse surgery.
This was a planned exploratory analysis of the Patient Preparedness for Pelvic Organ Prolapse Surgery study, which randomized women to standardized preoperative counseling by office visit or phone call before prolapse surgery. Inclusion criteria were the completion of the assigned counseling intervention and submission of a 7-day postoperative pain and medication diary. Multivariable logistic regression was done to assess the association between counseling method and total opioid use while controlling for variables significant on univariate analysis (surgery type and county of residence).
There were 84 participants with postoperative data (41 office, 43 phone). Median total number of 5-mg oxycodone tablets used was higher for the office group (5 [interquartile range, 0-10]) than the phone group (0 [interquartile range, 0-2], P = 0.002). On multivariable logistic regression, women who underwent phone counseling were less likely to be in the highest third of opioid use when controlling for surgery type and county of residence (odds ratio, 0.23; P = 0.012; 95% confidence interval, 0.07-0.72). Daily pain scores and nonopioid medication use (nonsteroidal anti-inflammatory medications and acetaminophen) were similar between groups (P > 0.05).
Despite similar pain scores, women who received preoperative phone counseling before pelvic organ prolapse surgery had lower opioid utilization than those with office counseling. Further research is needed to determine the optimal method of preoperative counseling and its role in postoperative pain management.
本分析旨在确定接受盆腔器官脱垂手术的女性在接受门诊或电话术前咨询后，其术后阿片类药物使用是否存在差异。
这是对盆腔器官脱垂手术患者准备情况研究的一项计划探索性分析，该研究将女性随机分为门诊或电话进行标准化术前咨询，然后进行脱垂手术。纳入标准为完成指定的咨询干预，并提交术后 7 天的疼痛和用药日记。采用多变量逻辑回归来评估咨询方法与总阿片类药物使用之间的关联，同时控制单变量分析中具有统计学意义的变量（手术类型和居住地县）。
共有 84 名女性有术后数据（41 名门诊，43 名电话）。使用的 5 毫克羟考酮片剂总数中位数在门诊组（5 [四分位间距，0-10]）高于电话组（0 [四分位间距，0-2]，P = 0.002）。在多变量逻辑回归中，控制手术类型和居住地县后，接受电话咨询的女性更不可能处于阿片类药物使用的最高三分之一（比值比，0.23；P = 0.012；95%置信区间，0.07-0.72）。两组每日疼痛评分和非阿片类药物使用（非甾体抗炎药和对乙酰氨基酚）相似（P > 0.05）。
尽管疼痛评分相似，但接受盆腔器官脱垂手术前电话术前咨询的女性比门诊咨询的女性阿片类药物使用率更低。需要进一步研究以确定术前咨询的最佳方法及其在术后疼痛管理中的作用。
