Perioperative Opioid Dispensing and Persistent Use After Benign Hysterectomy: A Systematic Review and Meta-analysis

Between 1999 and 2019, the opioid epidemic claimed the lives of nearly 250,000 individuals in the United States. Many patients first opioid prescription is dispensed in a surgical setting, and hysterectomy is the second most common surgical procedure in women. Despite several cohort studies examining the association of perioperative opioid dispensing and long-term use after benign hysterectomy, conflicting findings have led to a lack of conclusion. This systematic review and meta-analysis aimed to determine the association between perioperative opioid use and persistent opioid use after benign hysterectomy. All observational studies that reported opioid dispensing for patients undergoing benign hysterectomy were considered eligible. The primary outcome was the dosage of dispensed opioids during the perioperative period, and the secondary outcome was the assessment of risk factors associated with use of any opioid from3 months to 3 years after the surgery. A total of 8 studies met the inclusion criteria, 4 of which were retrospective and 4 prospective. The meta-analysis demonstrated that 83% (95% confidence interval [CI], 81-84) of patients undergoing benign hysterectomy were dispensed perioperative opioids, and the average amount prescribed was 143.5 morphine milligram equivalents (MME) (95% CI, 40-247). Patients that underwent vaginal hysterectomy were dispensed significantly lowerMME than patients undergoing laparoscopic (mean differences [MD], -47.4; 95% CI, -66.2 to -28.6) and abdominal hysterectomy (MD, -74.5; 95% CI, -99.1 to -49.8). The overall incidence of persistent opioid use after hysterectomy was 5% (95% CI, 2-8) and was not predicted by hysterectomy route. Risk factors for persistent opioid use include younger age (<45 years) (odds ratio [OR], 1.38; 95% CI, 1.17-1.63; P < 0.001), smoking history (OR, 1.87; 95% CI, 1.67-2.10; P < 0.001), alcohol use (OR, 3.16; 95% CI, 2.34-4.27; P < 0.001), fibromyalgia (OR, 1.60; 95% CI, 1.39-1.83; P < 0.001), and back pain (OR, 1.50; 95% CI, 1.10-2.05; P = 0.01). The results of this meta-analysis show a persistent opioid use rate of 5% associated with benign hysterectomy. The results suggest that although lower doses of opioids are prescribed for vaginal hysterectomy, the surgical route is not a predictor of persistent opioid use. The study's authors recommend further research to explore the effectiveness of alternative pain management strategies and to identify patients who are at high risk of developing persistent opioid use after hysterectomy.