Opioid Use After Robotic Assisted versus Laparoscopic Endometriosis Surgery

Area of Science:

• Minimally invasive gynecologic surgery
• Surgical oncology
• Pain management

Background:

• Minimally invasive endometriosis surgery can be performed laparoscopically or robotically.
• The surgical approach may influence post-procedure pain and opioid requirements.
• Understanding these differences is crucial for optimizing patient recovery and pain management strategies.

Purpose of the Study:

• To compare opioid prescription fill rates after robotic-assisted versus laparoscopic endometriosis surgery.
• To evaluate the impact of surgical modality on postoperative pain management needs.
• To identify potential differences in opioid use between the two surgical approaches.

Main Methods:

• Retrospective cohort study (2016-2021) using US employer-based claims data.
• Analysis of opioid prescription fills in preoperative, perioperative, and postoperative periods.
• Logistic regression models estimated average marginal effects (AME) for opioid use, adjusting for covariates.

Main Results:

• Laparoscopic surgery was linked to higher postoperative opioid prescription fills than robotic-assisted surgery (AME=3.2; P≤.01).
• Robotic-assisted surgery demonstrated lower postoperative opioid fills in patients with baseline pain disorders (AME=3.2; P=.04).
• A total of 28,088 patients underwent endometriosis surgery, with 6.24% receiving robotic assistance.

Conclusions:

• Robotic-assisted endometriosis surgery is associated with a decreased likelihood of postoperative opioid prescription fills compared to laparoscopic surgery.
• This opioid-sparing effect of robotic assistance extends to patients with pre-existing pain conditions.
• The findings suggest robotic assistance may offer advantages in postoperative pain management following endometriosis surgery.