Satisfaction with opioid prescription and use after minor gynaecologic surgery: a pilot prospective study

To describe predictors of patient satisfaction with pain control including opioid prescribing practices, patients undergoing minor gynaecologic and urogynaecologic surgeries were included in a prospective cohort study. Satisfaction with postoperative pain control by opioid prescription status was analysed using bivariate analysis and multivariable logistic regression, controlling for potential confounders. Among participants completing both postoperative surveys, 112/141 (79.4%) reported pain control satisfaction by day 1–2 and 118/137 (86.1%) by day 14. While we were underpowered to detect a true difference in satisfaction by opioid prescription, there were no differences in opioid prescription among patients satisfied with pain control [52% vs. 60% (<i>p</i> = .43) among satisfied patients at day 1–2 and 58.5% vs. 37% (<i>p</i> = .08) at day 14]. Significant predictors of pain control satisfaction were postoperative day (POD) 1–2 average pain at rest [aOR 0.72 (95% CI 0.52–0.99), <i>p</i> = .04], rating of shared decision-making [aOR 1.16 (95% CI 1.004–1.34), <i>p</i> = .04], amount of pain relief [aOR 1.28 (95% CI 1.07–1.54), <i>p</i> = .008) and POD 14 shared decision-making rating [aOR 1.45 (95% CI 1.19–1.77), <i>p</i> = .002].Impact Statement<b>What is already known</b><b>on this subject?</b> There are little data published on opioid prescription rates after minor gynaecologic procedures and no formal evidence-based guidance for gynaecologic providers for opioid prescribing. Few publications describe rates of opioid prescription and use following minor gynaecologic procedures. In the setting of a dramatic escalation of opioid misuse in the United States over the last decade, we sought to describe our practice of opioid prescription following minor gynaecologic procedures and answer the question of whether patient satisfaction is affected by opioid prescription, fill and use.<b>What do the results of this study add?</b> Though underpowered to detect our primary outcome, our results suggest that patient satisfaction with pain control may primarily be significantly affected by the patient’s subjective assessment of shared decision-making with the gynaecologist.<b>What are the implications of these findings for clinical practice and/or further research?</b> Ultimately, these preliminary findings suggest a larger cohort is needed to answer the question of whether pain control satisfaction is influenced by receipt/fill/use of opioids after minor gynaecologic surgery. <b>What is already known</b><b>on this subject?</b> There are little data published on opioid prescription rates after minor gynaecologic procedures and no formal evidence-based guidance for gynaecologic providers for opioid prescribing. Few publications describe rates of opioid prescription and use following minor gynaecologic procedures. In the setting of a dramatic escalation of opioid misuse in the United States over the last decade, we sought to describe our practice of opioid prescription following minor gynaecologic procedures and answer the question of whether patient satisfaction is affected by opioid prescription, fill and use. <b>What do the results of this study add?</b> Though underpowered to detect our primary outcome, our results suggest that patient satisfaction with pain control may primarily be significantly affected by the patient’s subjective assessment of shared decision-making with the gynaecologist. <b>What are the implications of these findings for clinical practice and/or further research?</b> Ultimately, these preliminary findings suggest a larger cohort is needed to answer the question of whether pain control satisfaction is influenced by receipt/fill/use of opioids after minor gynaecologic surgery.

本前瞻性队列研究（prospective cohort study）纳入接受小型妇科及泌尿妇科手术的患者，旨在探讨患者疼痛控制满意度的影响因素，包括阿片类药物（opioid）处方行为。研究采用双变量分析（bivariate analysis）与多变量logistic回归（multivariable logistic regression），控制潜在混杂因素（confounder），分析不同阿片类药物处方状态下患者的术后疼痛控制满意度。

在完成两份术后问卷的受试者中，112/141（79.4%）的患者在术后日（postoperative day, POD）1-2报告疼痛控制满意，118/137（86.1%）的患者在术后14日报告满意。尽管本研究检验效能不足，无法检测阿片类药物处方相关的真实满意度差异，但在疼痛控制满意的患者中，阿片类药物处方比例并无显著差异：术后日1-2满意患者中，阿片处方比例分别为52%与60%（*p*=0.43）；术后14日满意患者中分别为58.5%与37%（*p*=0.08）。

疼痛控制满意度的显著预测因素包括：术后日1-2静息平均疼痛评分[校正优势比（adjusted odds ratio, aOR）0.72，95%置信区间（confidence interval, CI）0.52~0.99，*p*=0.04]、共同决策（shared decision-making）评分[aOR 1.16，95%CI 1.004~1.34，*p*=0.04]、疼痛缓解程度[aOR 1.28，95%CI 1.07~1.54，*p*=0.008]以及术后14日共同决策评分[aOR 1.45，95%CI 1.19~1.77，*p*=0.002]。

**研究影响声明（Impact Statement）**
**该领域已有认知**
目前已发表的小型妇科手术后阿片类药物处方率相关数据极少，且尚无针对妇科医师的阿片类药物处方正式循证指南。现有文献中鲜有探讨小型妇科手术后阿片类药物处方与使用情况的研究。在过去十年美国阿片类药物滥用问题急剧恶化的背景下，本研究旨在描述小型妇科手术后的阿片类药物处方实践，并解答"患者满意度是否受阿片类药物处方、取药及使用情况影响"这一问题。

**本研究新增发现**
尽管本研究检验效能不足，无法检测主要结局指标，但研究结果提示，患者对疼痛控制的满意度主要受其与妇科医师共同决策的主观评估显著影响。

**研究结果对临床实践及/或后续研究的启示**
本初步研究结果最终表明，需开展更大样本量的队列研究，方能解答"小型妇科手术后，患者的疼痛控制满意度是否受阿片类药物获取、取药及使用情况影响"这一核心问题。

**该领域已有认知**
目前已发表的小型妇科手术后阿片类药物处方率相关数据极少，且尚无针对妇科医师的阿片类药物处方正式循证指南。现有文献中鲜有探讨小型妇科手术后阿片类药物处方与使用情况的研究。在过去十年美国阿片类药物滥用问题急剧恶化的背景下，本研究旨在描述小型妇科手术后的阿片类药物处方实践，并解答"患者满意度是否受阿片类药物处方、取药及使用情况影响"这一问题。

**本研究新增发现**
尽管本研究检验效能不足，无法检测主要结局指标，但研究结果提示，患者对疼痛控制的满意度主要受其与妇科医师共同决策的主观评估显著影响。

**研究结果对临床实践及/或后续研究的启示**
本初步研究结果最终表明，需开展更大样本量的队列研究，方能解答"小型妇科手术后，患者的疼痛控制满意度是否受阿片类药物获取、取药及使用情况影响"这一核心问题。