Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, New York, USA.
Pharmacoepidemiol Drug Saf. 2021 Aug;30(8):993-1002. doi: 10.1002/pds.5239. Epub 2021 Apr 19.
Opioid use after surgical repair for pelvic organ prolapse (POP) is intended for short-term post-operative pain. This study compared the incidence of opioid prescribing in women undergoing POP transabdominal repair with mesh and transvaginal native tissue repair.
A retrospective cohort of women undergoing POP transabdominal repair with mesh or transvaginal native tissue repair, was derived from a 10% random sample of enrollees from 2007 to 2015 within the IQVIA PharMetrics® Plus Database. Primary outcomes were any prescription of opioids and cumulative days of opioids prescribed in the 14- 180 days following surgical intervention. Inverse probability of treatment weights controlled for observed baseline confounders. Any opioid prescription was estimated using logistic regression and generalized linear regression for cumulative days of opioids prescribed.
The cohort of 49 052 women who underwent POP surgical repair included 46 813 women with transvaginal native tissue repair and 2239 women with transabdominal repair with mesh. Women with a transabdominal repair with mesh had a 1.19 (95%CI: 1.09-1.31) significantly higher odds of receiving an opioid prescription than women with transvaginal native tissue repair. Post-operatively, over 29% of women received opioid prescriptions. Mean cumulative days of post-surgical opioid prescribing was 32.2 (SD = 43.1), and was not statistically different between groups. Thirteen percent of women were prescribed opioids for 90 days or more.
Women undergoing POP with transabdominal mesh are more likely to receive prescriptions for opioids after surgery compared to transvaginal native tissue repair. Treatment plans that address pain while mitigating the risks associated with prolonged opioid prescribing should be employed.
盆腔器官脱垂（POP）手术后使用阿片类药物是为了短期缓解术后疼痛。本研究比较了经腹修补术联合网片修补与经阴道自然组织修补术治疗 POP 患者时开具阿片类药物处方的情况。
本研究从 IQVIA PharMetrics® Plus 数据库中 2007 年至 2015 年 10%的随机抽样登记患者中，提取了经腹修补术联合网片或经阴道自然组织修补术治疗 POP 的患者回顾性队列。主要结局是术后 14-180 天内开具任何阿片类药物处方和开具阿片类药物的累计天数。采用逆概率治疗权重控制观察到的基线混杂因素。采用逻辑回归估计任何阿片类药物处方，采用广义线性回归估计开具阿片类药物的累计天数。
纳入的 49052 例行 POP 手术治疗的患者中，46813 例接受经阴道自然组织修补术，2239 例接受经腹修补术联合网片。与经阴道自然组织修补术相比，经腹修补术联合网片的患者开具阿片类药物处方的可能性高 1.19（95%CI：1.09-1.31）。术后，超过 29%的患者开具了阿片类药物处方。术后阿片类药物处方的累计天数为 32.2（SD=43.1），两组间无统计学差异。13%的患者开具阿片类药物处方的时间超过 90 天。
与经阴道自然组织修补术相比，经腹修补术联合网片修补 POP 的患者术后更有可能开具阿片类药物处方。应制定治疗计划以缓解疼痛，同时减轻长期开具阿片类药物处方的风险。
