Opioid analgesics following surgery for gynecologic cancer patients at a university health center: have we altered our prescribing patterns in this patient population?

Objectives: Our objective was to analyze the effect of increased opioid prescribing regulations, implemented as an updated state law in July 2016, on the number of opioid tablets prescribed to postoperative gynecologic oncology patients at a state-funded university health center. Methods: This Institutional Review Board (IRB)-approved, retrospective review utilized several electronic health records systems and our referral list to identify patients who qualified. Patients were included in the study if they received surgery performed by a gynecologic oncologist for suspicious masses, premalignant or malignant conditions of the uterus, tubes, ovaries or cervix. The charts were divided into Before July 2016 and After July 2016. The number of opioids prescribed to patients at time of discharge was recorded when available. Qualitative data was collected including the prescription or recommendation for non-opioid analgesics within the discharge summary, and type of procedure conducted (open versus minimally invasive). Demographic information including age, ethnicity and insurance coverage was also recorded. The study was designed to detect a 25% decrease in opioid tablets prescribed after the regulation was implemented (alpha = 0.05, power 0.8). Comparisons were made between groups after a Kolmogorov-Smirnov and Shapiro-Wilk test determined that the data was not normally distributed. Therefore, we utilized Mann-Whitney U tests to compare number of opioid tabs prescribed and to compare median age between the Before and After July 2016 groups. We used Chi-Square and Fischer Exact tests to compare differences in ethnicity and non-opioid analgesic (NSAID) use between the Before and After July 2016 groups. Finally, we utilized a multivariate linear regression model to determine if ethnicity and NSAID use significantly impacted the number of opioid tablets prescribed. Statistical analyses were performed utilizing SPSS software version 25. Results: We identified a statistically significant, 50% decrease in the number of opioid tablets prescribed after gynecologic oncology surgeries after July 2016. As anticipated, we also saw fewer opioid tablets prescribed following minimally invasive procedures compared to open cases (p=0.007). When examining non-opioid analgesic data, we identified significantly more patients received a prescription for non-opioid analgesics in the After July 2016 group compared to the Before July 2016 group (p Conclusions: This study confirms there was a significant decrease in the number of opioid tablets prescribed to postoperative gynecologic oncology patients at discharge since July 2016 in our state-funded university hospital. The difference cannot be attributed to the change in the regulatory guidelines alone, but is temporally related to the updated provider requirements. These results reemphasize that minimally invasive surgery has a reduced number of prescribed opioids, inferring a decreased amount of postoperative analgesic requirements. Multi-institutional study is required with more patients to detail the factors involved in further decreasing opioid prescribing and use. It appears from these results that increasing regulatory oversight is an important variable in harnessing the opioid epidemic.