Shared decision-making in opioid prescribing for minimally invasive hysterectomy: A prospective randomized controlled trial

Authors

DOI:

https://doi.org/10.5055/jom.2022.0741

Keywords:

individualized prescribing, minimally invasive hysterectomy, opioid utilization, patient satisfaction, perioperative pain management, post-operative pain

Abstract

Objective: To determine the impact of shared decision-making in postsurgical 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.

Author Biographies

Ritchie Delara, MD

Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona

Mohammad Islam, MD

Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona

Nalani Thomas, BS

Department of Clinical Research, Mayo Clinic, Phoenix, Arizona

Lanyu Mi, MS

Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Phoenix, Arizona

Elisabeth Lim, MPH

Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Phoenix, Arizona

Johnny Yi, MD

Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona

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Published

09/01/2022

How to Cite

Delara, MD, R., M. Islam, MD, N. Thomas, BS, L. Mi, MS, E. Lim, MPH, and J. Yi, MD. “Shared Decision-Making in Opioid Prescribing for Minimally Invasive Hysterectomy: A Prospective Randomized Controlled Trial”. Journal of Opioid Management, vol. 18, no. 5, Sept. 2022, pp. 475-8, doi:10.5055/jom.2022.0741.