Opioid Pain Medication Use In Urogynecology And Gynecology Patients

To determine the prevalence of opioid pain medication use among patients presenting for a new visit to the Urogynecology clinic compared to those presenting to general Gynecology. We identified all patients who presented for new patient visits at the University of Oklahoma Urogynecology and Gynecology clinics between January 1, 2016 and December 31, 2016. Exclusion criteria included pregnancy and age < 18 years. Opioid use was extracted from the electronic medical record medication list provided by patients. Statistical analysis was performed using chi square tests and Fisher’s exact tests for bivariate comparisons. Modified poisson regression models were used to estimate prevalence proportion ratios (PPR) and 95% confidence intervals adjusted for patient characteristics. A p value < 0.05 was considered statistically significant. There were 2790 (1905 Gynecology, 885 Urogynecology) new patients seen during the study period. Of this total, 1835 (955 Gynecology, 880 Urogynecology) patients met inclusion criteria. Median age of patients was 47 (interquartile range (IQR) 29) years, median parity was 2 (IQR 3), and median body mass index (BMI) was 28.15 (IQR 9.96) kg/m2. The majority of patients identified as White (78.6%). Patient characteristics differed by clinic with a greater proportion of Urogynecology patients ≥ 60 years, obese, and having a history of alcohol abuse, depression, and previous pain diagnosis. New Urogynecology patients were almost twice as likely to have a history of opioid use when compared to Gynecology patients (14.2% (95% CI 11.9-16.5) vs 7.64% (95% CI 6.0-9.3), p <0.0001. Increasing age, obesity, cigarette smoking, history of depression, and previous pain diagnosis were all associated with an increased proportion of opioid use. Alcohol use was not associated with use opioid pain medications. Prevalence of opioid use was lowest among women who identified as Asian or other race, and highest among Black women; however, when opioid use was compared by ethnicity, use was lowest among Hispanic women (p = 0.01). Self-reported opioid use was almost twice as likely in the Urogynecology group (PPR 1.86; 95% CI 1.41-2.44). When adjusted for age, race, Hispanic ethnicity, parity, body mass index, alcohol, tobacco, depression, pain diagnosis and psychiatric diagnosis, the Urogynecology group was 1.3 times more likely to report opioid use (PPR 1.29; 95% CI 0.95 - 1.75) with this result approaching statistical significance. Opioid use is greater in patients presenting to the Urogynecology clinic compared to general Gynecology. Urogynecologists need to know this information for planning and optimizing pain management in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)