Chailee Moss Mentor Michelle Isley Disclosures None Ohio State University Institutional Review Board Exempt Study Narcotic Addiction and Physician Prescriptions Narcotic overdose death increased from 62 to ID: 597934
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Slide1
Narcotic Prescriptions for Benign Gynecology Procedures
Chailee
Moss
Mentor: Michelle
Isley
Disclosures: None
Ohio State University Institutional Review Board Exempt StudySlide2
Narcotic Addiction and Physician Prescriptions
Narcotic overdose death increased from 6.2 to
14.7 per 100,000
people from 2000 to 2014Many opiate addictions stem from legal prescriptionsExcess opiate prescription has significant consequences:Patient seek illicit opiates to avoid withdrawalHousehold members ingest deliberately or accidentallyCost burdens social, emergency, and substance treatment resources
Rudd 2016; Becker 2008; Compton 2016Slide3
Prescriptions for Benign Gynecology Procedures
Swenson
et
al.Fifty women undergoing urogynecologic surgeryMean patient pill use was 13 of 40 prescribed tabletsThose using more than 30 (n=12) were:
More frequently taking narcotics preoperatively (13.2% vs 41.7%; P=0.03)
More likely to carry a chronic pain diagnosis (15.8% vs 58.3%; P=0.003). Slide4
Retrospective Cohort
Goal to characterize and describe narcotic prescription practices for uncomplicated gynecology cases
Included:
General gynecology faculty member casesJanuary, April, August, October 2014, 2015Exclusions:Age <18 years old
Complications: Bleeding requiring transfusion, infection, surgery for surgical complication, surgical complication
Patient under pain contract
Joint surgical case or management on another service
After exclusions, 540 cases to examineSlide5
Data Collection
Type
of Procedure
Vulvar and Cervical ProceduresUterine (e.g. dilation and curettage,
hysteroscopy)
Outpatient Laparoscopy
Inpatient Minimally Invasive Procedures
Open Procedures
Demographics
Age
Weight
Insurance status
Race
Ethnicity
Provider Type
Resident
Attending
Narcotics
-Discharge narcotic prescription
-Narcotic
exposure in 5 years prior to procedure
-Narcotic prescription two weeks prior to procedure
-Narcotic prescription two weeks after procedureSlide6
Demographics
Race
n
(%) African
American
White
Other
172 (31)
323 (58)
53 (10)
Case Type
percentage
Private
Resident
63.6
36.2
Average Weight
kg
82
Average age
Years
39
Insurance Type
n
(%)
Private
Public
None
Incarcerated
236 (43)
269 (49)
32 (7)
5
(1)Slide7
Results
Case type
N (%)
Mean Oral Morphine Dose Prescribed (Standard Deviation)
Vulvar
, Cervical Surg.
60 (10.9)
90 (106)
Uterine Procedures
238 (43.4)
49 (58)
Outpatient Laparoscopy
114 (20.8)
137
(72)
Inpatient
Minimally Invasive Surgery
82 (14.9)
267 (94)
Open Surgery
55 (10)
323 (140)
Narcotic Exposure in 5 years prior
to Procedure
43%
n/aSlide8
Maximum
Minimum
Q3
Median
Q1Slide9
Analysis
Welch ANOVA and a Games-Howell post-hoc test were conducted. The results indicated:
Open surgery cases had significantly higher narcotics than
vulvar and cervical procedures (p < .001), uterine procedures (p < .001), outpatient laparoscopy (
p
< .001), and inpatient minimally invasive cases (
p
= .023).
Inpatient minimally invasive cases had significantly higher levels of narcotics than
vulvar
and cervical procedures (
p
< .001), uterine procedures (
p
< .001), and outpatient laparoscopy (
p
< .001).Outpatient laparoscopy had higher levels of narcotics than uterine procedures (p < .001).
Hysteroscopy/D&C/Ablation procedures prescribed significantly lower levels of narcotics than all of the other procedures except
vulvar
and cervical procedures
No differences based on race, age, weight, insurance status, or care team of the patient (Pearson’s Correlation Coefficient)Slide10
Why are prescriptions so variable? Slide11
Strengths and Weaknesses
Strengths
Attempts to eliminate bias
Sample sizeWeaknessesHeterogeneity of procedures and patient medical historyCould not account for paper prescriptions or non-IHIS prescriptionsSingle person data entryRetrospectiveProvider-centeredSlide12
Conclusions
Narcotic over-prescription is of significant public health importance
No standard of care exists for the number of narcotics prescribed for a given procedure
Prescriptions vary widely within a given procedure or provider, but do correlate with procedure typeResident variation in prescribing practice may contribute to the wide range of prescription levelsNext steps: Survey patients to determine patterns of useConsider prospective study with assigned narcotic prescriptionSlide13
Thank You
Dr.
Isley
Matthew Vetter (and Monica Vetter)OSU residents and facultySlide14
References
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The American Journal on Addictions, 16: 166–173, 2007
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