TY - JOUR
T1 - Shared decision-making in opioid prescribing for minimally invasive hysterectomy
T2 - A prospective randomized controlled trial
AU - Delara, Ritchie
AU - Islam, Mohammad
AU - Thomas, Nalani
AU - Mi, Lanyu
AU - Lim, Elisabeth
AU - Yi, Johnny
N1 - Publisher Copyright:
© 2022 Journal of Opioid Management, All Rights Reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Objective: To determine the impact of shared decision-making in post-surgical opioid prescribing in women who underwent minimally invasive (MIS) hysterectomy. Design: A randomized controlled trial. Setting: A single, tertiary care, academic center. Patients and participants: From January 2019 through April 2020, 73 women aged 18 years and older who had a planned MIS hysterectomy with the Department of Gynecology were enrolled into the study (36 in the standard arm and 37 in the patient-directed arm). Interventions: Participants were assigned either to the standard arm (30 tablets) or patient-directed arm (0-30 tablets) of oxycodone 5 mg. Main outcome measures: The primary outcome was the percentage of excess opioid tablets, calculated by the number of unused tablets divided by the number of tablets prescribed. Secondary outcomes included total opioid tablets used, frequency of obtaining additional opioid tablets after discharge, frequency of unscheduled post-operative visits, and patient satisfaction with number of opioid tablets prescribed. Results: Age, race, and body mass index did not differ between groups. Hysterectomies were performed via laparoscopy (16.9 percent), robotic-assisted laparoscopy (38.5 percent), and vaginal routes (44.6 percent). The median (IQR) number of oxycodone prescribed in the patient-directed arm was 15.0 (12.0 and 24.0) tablets. The standard arm had a greater percentage of excess oxycodone tablets 73.6 percent (0.03) than the patient-directed arm 56.3 percent (0.03, p < .01). However, there was no difference in the total number of oxycodone used by patients in the standard (mean 7.9 [0.5] tablets) and patient-directed arms (mean 8.4 [0.5] tablets, p = .50). The mean number of oxycodone used for the entire cohort was 8.1 (0.4) tablets. Conclusions: Shared decision-making significantly decreased the percent of excess oxycodone tablets but did not decrease the total number of oxycodone tablets used in patients undergoing MIS hysterectomy. Patients used about 22 tablets less than the standard 30 tablets prescribed.
AB - Objective: To determine the impact of shared decision-making in post-surgical opioid prescribing in women who underwent minimally invasive (MIS) hysterectomy. Design: A randomized controlled trial. Setting: A single, tertiary care, academic center. Patients and participants: From January 2019 through April 2020, 73 women aged 18 years and older who had a planned MIS hysterectomy with the Department of Gynecology were enrolled into the study (36 in the standard arm and 37 in the patient-directed arm). Interventions: Participants were assigned either to the standard arm (30 tablets) or patient-directed arm (0-30 tablets) of oxycodone 5 mg. Main outcome measures: The primary outcome was the percentage of excess opioid tablets, calculated by the number of unused tablets divided by the number of tablets prescribed. Secondary outcomes included total opioid tablets used, frequency of obtaining additional opioid tablets after discharge, frequency of unscheduled post-operative visits, and patient satisfaction with number of opioid tablets prescribed. Results: Age, race, and body mass index did not differ between groups. Hysterectomies were performed via laparoscopy (16.9 percent), robotic-assisted laparoscopy (38.5 percent), and vaginal routes (44.6 percent). The median (IQR) number of oxycodone prescribed in the patient-directed arm was 15.0 (12.0 and 24.0) tablets. The standard arm had a greater percentage of excess oxycodone tablets 73.6 percent (0.03) than the patient-directed arm 56.3 percent (0.03, p < .01). However, there was no difference in the total number of oxycodone used by patients in the standard (mean 7.9 [0.5] tablets) and patient-directed arms (mean 8.4 [0.5] tablets, p = .50). The mean number of oxycodone used for the entire cohort was 8.1 (0.4) tablets. Conclusions: Shared decision-making significantly decreased the percent of excess oxycodone tablets but did not decrease the total number of oxycodone tablets used in patients undergoing MIS hysterectomy. Patients used about 22 tablets less than the standard 30 tablets prescribed.
KW - individualized prescribing
KW - minimally invasive hysterectomy
KW - opioid utilization
KW - patient satisfaction
KW - perioperative pain management
KW - post-operative pain
UR - http://www.scopus.com/inward/record.url?scp=85139761984&partnerID=8YFLogxK
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U2 - 10.5055/JOM.2022.0741
DO - 10.5055/JOM.2022.0741
M3 - Article
C2 - 36226787
AN - SCOPUS:85139761984
SN - 1551-7489
VL - 18
SP - 475
EP - 485
JO - Journal of opioid management
JF - Journal of opioid management
IS - 5
ER -