Patterns of narcotic utilization in women undergoing hysterectomy for benign indications.

OBJECTIVE

To determine whether perioperative narcotic utilization at the time of hysterectomy has decreased since 2012.

STUDY DESIGN

Retrospective cohort study.

SETTING

Academic university hospital.

PATIENTS

Patients who underwent a laparoscopic hysterectomy for benign indications between January 2012 and December 2018.

INTERVENTIONS

Perioperative narcotics administration.

MEASUREMENTS AND MAIN RESULTS

We identified 651 patients who underwent a hysterectomy for benign indications from 2012 to 2018. Of these, 377 surgeries were performed using robotic-assistance (58%) and the remainder (42%) were performed by conventional laparoscopy. Narcotic utilization declined significantly by year for both intra-operative and post-operative periods (both p<.001). The largest decline for intraoperative morphine milligram equivalents (MME) was between 2016 and 2017, while for post-operative MME, it was between 2012 and 2013. The pattern remained significant after adjusting for covariates. Intraoperative MME administration was correlated with postoperative MME use (Spearman r = 0.23, p<.001). Of the demographic variables only Body Mass Index was significantly associated with perioperative narcotic administration.

CONCLUSION

Administration of opioids for intraoperative and postoperative pain after minimally invasive hysterectomy substantially decreased from 2012 to 2018. Intraoperative narcotic utilization was correlated with immediate postoperative narcotic consumption. Heightened awareness of opioid administration practices during and immediately following surgery is critically important to decreasing risk of chronic opioid dependence and providing the best possible care for the patients we serve.