Evaluation In-Hospital Opioid Usage for Minimally Invasive Repair of Pelvic Organ Prolapse

To evaluate in-hospital analgesic use patterns for pelvic organ prolapse (POP) repair and identify predictors of higher opioid prescribing using a large, national patient administrative database.

This retrospective cohort study used a large, national administrative database (2010-2022) to identify women undergoing vaginal non-apical (NAR), vaginal apical (VAR), laparoscopic apical (LAR), or robotic apical (RAR) repairs. Opioid doses were converted to morphine milligram equivalents (MME). The primary outcome was total opioid, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAID) use. Secondary outcomes included differences in analgesic doses by surgical approach, predictors of higher POD-0 opioid use, postoperative 30-day readmission/emergency room (ER) visit rate, and the relationship between opioid use and 30-day readmission/ER visits.

Among 102,329 procedures, median POD-0 opioid dose was lowest in NAR (77.5 MME) (p < 0.001). NSAID and acetaminophen use was more common with minimally invasive approaches. Concurrent hysterectomy was the strongest predictor of higher POD-0 opioid use (exp(β) = 1.41, p < 0.001), along with adhesiolysis (exp(β) = 1.26, p < 0.001), bladder injury repair (exp(β) = 1.24, p < 0.001), anti-incontinence procedures (exp(β) = 1.05, p < 0.001), noncommercial insurance (exp(β) = 1.04, p = 0.002), and large hospital size (exp(β) = 1.09, p = 0.037). Older age (exp(β) = 0.87 per decade, p < 0.001), high Elixhauser comorbidity index (exp(β) = 0.9, p < 0.001), and NAR (exp(β) = 0.93, p < 0.001) were associated with lower opioid use. Receiving > 90 MME on POD-0 was linked to higher 30-day readmission/ER visit rates (8.3% vs 5.6%; p < 0.001, respectively).

Apical repair techniques did not show significant differences in predicting higher opioid use. Concurrent hysterectomy was the strongest predictor of higher opioid use. Higher opioid doses on POD-0 were associated with increased 30-day readmission/ER rates.