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Narcotic Prescriptions for Benign Gynecology Procedures Narcotic Prescriptions for Benign Gynecology Procedures

Narcotic Prescriptions for Benign Gynecology Procedures - PowerPoint Presentation

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Narcotic Prescriptions for Benign Gynecology Procedures - PPT Presentation

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

narcotic procedures procedure prescription procedures narcotic prescription procedure prescriptions narcotics 001 cases type patient surgery pain vulvar cervical uterine

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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

Becker, WC, Sullivan LE,

Tetrault

JM, Desai RA, Fiellin DA. "Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates." Drug Alcohol Depend 94 (2008): 38-47.Compton, WM et al. "Relationship between Nonmedical Prescription-Opioid

Use and Heroin Use."

The New England Journal of Medicine

374 (2016): 154-63.

Grau

, LE et al. "Illicit Use of

Opioids

: Is OxyContin1 a ‘‘Gateway Drug’’?"

The American Journal on Addictions, 16: 166–173, 2007

16 (2007): 166-173.

Macintyre, PE et al. "Costs and consequences: a review of discharge

opioid

prescribing for ongoing management of acute pain."

Anaesthesia

Intensive Care

42.5 (2014): 558-74.

Pinto, PR , McIntyre T,

Araújo-Soares V, Costa P, Almeida A. "Differential Predictors of Acute Post-Surgical Pain Intensity After Abdominal Hysterectomy and Major Joint Arthroplasty."

Annals of Behavioral Medicine

49 (2015): 384-397.

Rudd, RA,

Aleshire

N,

Zibbell

JE, Gladden RM. "Increases in Drug and

Opioid

Overdose Deaths--United States, 2000-2014."

Morbidity and Mortality Weekly Report

0149-2195.64(50-51) (2016): 1378.

Shah, AA,

Zogg

CK,

Zafar

SN, Schneider EB, Cooper LA,

Chapital

AB, Peterson SM, Havens JM, Thorpe RJ

Jr

,

Roter

DL, Castillo RC,

Salim

A,

Haider

AH. "Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination."

Medical Care 2015 Dec;53(12):1000-9

53.12 (2015): 1000-9.