Opioid use following pelvic reconstructive surgery: a predictive calculator

Introduction and hypothesis Our objective was to evaluate the amount of opioids used by patients undergoing surgery for pelvic floor disorders and identify risk factors for opioid consumption greater than the median. Methods This was a prospective cohort study of 18- to 89-year-old women undergoing major urogynecological surgery between 1 November2020 and 15 October 2021. Subjects completed one preoperative questionnaire (“questionnaire 1”) that surveyed factors expected to influence postoperative pain and opioid use. At approximately 1 and 2 weeks following surgery, patients completed two additional questionnaires (“questionnaire 2” and “questionnaire 3”) about their pain scores and opioid use. Risk factors for opioid use greater than the median were assessed. Finally, a calculator was created to predict the amount of opioid used at 1 week following surgery. Results One hundred and ninety patients were included. The median amount of milligram morphine equivalents prescribed was 100 (IQR 100–120), whereas the median amount used by questionnaire 2 was 15 (IQR 0–50) and by questionnaire 3 was 20 (IQR 0–75). On multivariate logistic regression, longer operative time (aOR 1.64 per hour of operative time, 95% CI 1.07–2.58) was associated with using greater than the median opioid consumption at the time of questionnaire 2; whereas for questionnaire 3, a diagnosis of fibromyalgia (aOR=16.9, 95% CI 2.24–362.9) was associated. A preliminary calculator was created using the information collected through questionnaires and chart review. Conclusions Patients undergoing surgery for pelvic floor disorders use far fewer opioids than they are prescribed.