University of Wisconsin–Madison Medical College of Wisconsin

Postoperative Prescribing Practices Following Gynecologic Surgery

Rachel J. Craven, MS; Madeline K. Moureau, BS; Heidi W. Brown, MD, MAS; Emily M. Buttigieg, MD

WMJ. 2024;123(1):24-28.

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Background: Opioids prescribed for postoperative pain have exceeded patient need in the United States, playing a significant role in the opioid epidemic. In the preintervention phase of this project (September 2018 – March 2019), a chart review and patient survey revealed that patients were prescribed double the number of opioids they consumed following gynecologic surgery.

Objective: To ascertain whether an educational intervention recommending opiate prescriptions based on postoperative opioid use decreases gynecologic surgeons’ opiate prescriptions.

Methods: An educational intervention implemented in January 2021 communicated the discrepancy between patient need and medications prescribed and made prescribing recommendations for common gynecologic procedures. A postintervention (February 2021 – April 2021) retrospective chart review ascertained postoperative opioid prescribing practices. Residents were surveyed about their prescribing practices in June 2021. Descriptive statistics compared each phase.

Results: For laparoscopic hysterectomy, the median morphine milligram equivalent (MME) was 150 (IQR 112.5-166.9) for preintervention and 150 (IQR 112.5-150) postintervention. For vaginal hysterectomy, median MME declined from 150 (IQR 112.5-225) to 112.5 (IQR 112.5-150). For laparoscopic surgery without hysterectomy, the median MME was 75 for both preintervention (IQR 75-120) and postintervention (IQR 60-80). For vaginal surgery without hysterectomy median MME went from 75 (IQR 75-142.5) to 54 (IQR 22.5-112.5). Median MME for hysteroscopy and dilation and curettage was 0 for both phases. When surveyed, residents reported prescribing lower amounts than actual prescribing practices.

Conclusions: Despite education informing gynecologic surgeons that their opioid prescribing exceeded patient need, prescribing practices did not change. The difference between actual and resident-reported prescribing practices warrants further investigation.

Author Affiliations: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Craven, Moureau, Brown); Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (Buttigieg).
Corresponding Author: Emily M. Buttigieg, MD, Comprehensive Health Care Center, 315 E 161st St, Bronx, NY 10451; phone 734.250.5023; email; ORCID ID 0000-0002-9541-4120
Funding/Support: Rachel Craven’s work on this project was funded by the Department of Ob/Gyn Start Up funds awarded to Heidi Brown (Department of Obstetrics and Gynecology Start Up Funds, University of Wisconsin School of Medicine and Public Health).
Financial Disclosures: None declared.
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