1725 Dual-Opioid Post-Operative Prescription Model in Gynecologic Surgery – A Pilot Study

Study Objective Determine if providing two opioid prescriptions postoperatively is an effective strategy to decrease total number of opioids obtained. Design Retrospective descriptive study. Setting Tertiary care academic institution. Patients or Participants Thirty-nine patients undergoing gynecologic surgery. Interventions Two oral narcotic prescriptions were provided post-operatively. Patients were instructed to initially fill the first prescription with 10 pills. If the patient continued to have opioid requirement for pain control, she was instructed to fill the second prescription with an additional 20 pills. Opioids obtained within 6 weeks post-operatively were confirmed utilizing the Arizona Board of Pharmacy Controlled Substance Monitoring Program. Measurements and Main Results Thirty-nine patients underwent gynecologic surgery via laparoscopy or robotics (N=26), laparotomy (N=3), or vaginal routes (N=10). In the post-operative period, 24 patients (61.5%) filled only 10 pills and 15 patients (38.4%) filled the additional 20 pills (CI 44.62%-76.64% p-value 0.15). Patients filling only one prescription versus two prescriptions were not affected by age (49.6 years vs. 43.2 years, p-value 0.193), BMI (26.9 kg/m2 vs. 29.3 kg/m2 p-value 0.157), history of chronic pain (25% vs. 46.7%, p-value 0.163), smoking history (never smokers 66.7% vs. 66.7%, p-value 0.713), or post-operative IV narcotic use (morphine milligram equivalents) prior to discharge (23.3 mg vs. 31.2 mg p-value 0.187). There were no pain related post-operative clinic visits. Conclusion Providing dual narcotic prescriptions after gynecologic surgery can decrease the number of opioids obtained by patients postoperatively. Patient characteristics cannot be used to predict who fills the second prescription. This strategy was not associated with pain related post-operative visits.