The Effect Of State Legislation On Opioid Prescribing Practices Following Gynecologic Surgery

Objective: To compare the quantity in morphine milligram equivalent (MME) of opioids prescribed at hospital discharge after gynecologic surgery before and after passage of comprehensive New Hampshire state legislation (HB 1423) regulating opioid prescribing.Design: A retrospective chart review was performed on all patients undergoing gynecologic surgery between January 1, 2016 and June 30, 2016 (before legislation) and between April 1, 2017 and September 30, 2017 (after legislation) at a single tertiary care center.Materials and Methods: The primary outcome was MME prescribed at hospital discharge. Secondary outcomes included discharge without opioids, prescriptions <= 37.5 and >= 200 MME. Type of gynecologic surgery and benign versus oncologic diagnoses were analyzed. A logistic regression model was conducted to determine variables associated with a prescription of >= 200 MME.Results: Seven hundred seventy-four patients underwent gynecologic procedures during the identified time periods; 349 patients before legislation and 423 patients after legislation. Significantly fewer mean MME were prescribed after legislation (173 MME vs. 78.5 MME, p < 0.001). This was true for laparotomy with hysterectomy (231 MME vs. 111 MME; p < 0.001), laparotomy without hysterectomy (275 MME vs. 141 MME; p = 0.04), laparoscopic hysterectomy (143 MME vs. 62 MME; p < 0.001), other laparoscopy (133 MME vs. 59 MME; p < 0.001), and vaginal hysterectomy (232 MME vs. 89 MME; p = 0.002) and among those with a cancer diagnosis (178.5 vs. 67.9; p < 0.001). The number of patients discharged without a prescription for opioids significantly increased after legislation (4.4% vs. 9.8%; p = 0.005). In multivariate analysis, surgery before legislation (odds ratio [OR] 14.56 [95% confidence interval 8.22-25.82]), having a laparotomy with hysterectomy (OR 5.85 [2.47-13.85]) or laparotomy without hysterectomy (OR 6.35 [2.35-17.13]) were predictive of a prescription >= 200 MME.Conclusion: After opioid prescribing legislation in New Hampshire, significantly fewer opioids were prescribed on hospital discharge after gynecologic surgery. This reduction was seen regardless of type of gynecologic surgery or cancer diagnosis.