Personalized Prediction of Opioid Demand After Surgery for Pelvic Organ Prolapse: A Randomized Controlled Trial

Hope H Bauer; Maura A Schlussel; Emily A Hoffberg; Kasey M Palm; Stephen P Rhodes; Susan D Wherley; Margot Le Neveu; Sarah B Sears; Gabriella M Rustia; Adonis K Hijaz; Sangeeta T Mahajan; Anne G Sammarco; David Sheyn

doi:10.1097/AOG.0000000000005969

Personalized Prediction of Opioid Demand After Surgery for Pelvic Organ Prolapse: A Randomized Controlled Trial

Obstet Gynecol. 2025 Jun 26;146(2):285-292. doi: 10.1097/AOG.0000000000005969.

Authors

Hope H Bauer¹, Maura A Schlussel, Emily A Hoffberg, Kasey M Palm, Stephen P Rhodes, Susan D Wherley, Margot Le Neveu, Sarah B Sears, Gabriella M Rustia, Adonis K Hijaz, Sangeeta T Mahajan, Anne G Sammarco, David Sheyn

Affiliation

¹ Division of Urogynecology, Department of Urology, the Department of Obstetrics and Gynecology, the Department of Urology, and the Division of Urogynecology, Department of Obstetrics and Gynecology, UH Cleveland Medical Center, Cleveland, and the Division of Urogynecology, OhioHealth Physicians Group, Riverside Methodist Hospital, Columbus, Ohio.

PMID: 40570353
DOI: 10.1097/AOG.0000000000005969

Abstract

Objective: To evaluate whether a previously developed predictive model for postoperative opioid prescription reduces opioid utilization without increasing the risk of undertreatment of pain after surgery for pelvic organ prolapse (POP).

Methods: This was a randomized controlled trial of patients undergoing surgery for POP at an academic medical center. Patients were randomized to an opioid prescription based on the predictive model or a control opioid prescription. The primary outcome was morphine milligram equivalents (MMEs) remaining after 14 days, with 7.5 MMEs equating to one tablet of 5 mg oxycodone. Secondary outcomes included MMEs prescribed, MMEs used, and patient satisfaction. Group differences in average outcomes were estimated with analysis of covariance (ANCOVA). It was determined a priori that 51 patients in each group were required to see a 20% difference in MMEs remaining.

Results: Between January 2023 and January 2024, 110 patients were randomized, and ultimately 102 were included in the analysis: 51 patients in the predictive model group and 51 in the control group. The control group had a significantly higher average amount of opioids remaining at 14 days after surgery (mean±SD MMEs remaining 57.7±31.0) relative to the predictive model group (mean MME±SD remaining 16.8±21.1), with an average treatment effect from ANCOVA of -42.8 (95% CI, -54.0 to -31.7, P <.001). The control group was prescribed significantly more on the day of discharge (average treatment effect -56.5, 95% CI, -65.5 to 47.5, P <.001), but the two groups did not differ significantly in the total MMEs used over the first 2 weeks after surgery (average treatment effect -2.3, 95% CI, -13.4 to 8.7, P =.68). There was no significant difference in average patient satisfaction at week 1 or 2.

Conclusion: A predictive model for opioid prescribing after POP surgery was associated with fewer prescribed and leftover opioids without compromising effective pain management.

Clinical trial registration: ClinicalTrials.gov, NCT05571072.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Analgesics, Opioid* / administration & dosage
Analgesics, Opioid* / therapeutic use
Female
Humans
Middle Aged
Oxycodone / therapeutic use
Pain, Postoperative* / drug therapy
Patient Satisfaction
Pelvic Organ Prolapse* / surgery

Substances

Analgesics, Opioid
Oxycodone

Associated data

ClinicalTrials.gov/NCT05571072