Development and Validation of a Model for Opioid Prescribing Following Gynecological Surgery.
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2022-07
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Abstract
Importance
Overprescription of opioid medications following surgery is well documented. Current prescribing models have been proposed in narrow patient populations, which limits their generalizability.Objective
To develop and validate a model for predicting outpatient opioid use following a range of gynecological surgical procedures.Design, setting, and participants
In this prognostic study, statistical models were explored using data from a training cohort of participants undergoing gynecological surgery for benign and malignant indications enrolled prospectively at a single institution's academic gynecologic oncology practice from February 2018 to March 2019 (cohort 1) and considering 39 candidate predictors of opioid use. Final models were internally validated using a separate testing cohort enrolled from May 2019 to February 2020 (cohort 2). The best final model was updated by combining cohorts, and an online calculator was created. Data analysis was performed from March to May 2020.Exposures
Participants completed a preoperative survey and weekly postoperative assessments (up to 6 weeks) following gynecological surgery. Pain management was at the discretion of clinical practitioners.Main outcomes and measures
The response variable used in model development was number of pills used postoperatively, and the primary outcome was model performance using ordinal concordance and Brier score.Results
Data from 382 female adult participants (mean age, 56 years; range, 18-87 years) undergoing gynecological surgery (minimally invasive procedures, 158 patients [73%] in cohort 1 and 118 patients [71%] in cohort 2; open surgical procedures, 58 patients [27%] in cohort 1 and 48 patients [29%] in cohort 2) were included in model development. One hundred forty-seven patients (38%) used 0 pills after hospital discharge, and the mean (SD) number of pills used was 7 (10) (median [IQR], 3 [0-10] pills). The model used 7 predictors: age, educational attainment, smoking history, anticipated pain medication use, anxiety regarding surgery, operative time, and preoperative pregabalin administration. The ordinal concordance was 0.65 (95% CI, 0.62-0.68) for predicting 5 or more pills (Brier score, 0.22), 0.65 (95% CI, 0.62-0.68) for predicting 10 or more pills (Brier score, 0.18), and 0.65 (95% CI, 0.62-0.68) for predicting 15 or more pills (Brier score, 0.14).Conclusions and relevance
This model provides individualized estimates of outpatient opioid use following a range of gynecological surgical procedures for benign and malignant indications with all model inputs available at the time of procedure closing. Implementation of this model into the clinical setting is currently ongoing, with plans for additional validation in other surgical populations.Type
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Rodriguez, Isabel V, Paige McKeithan Cisa, Karen Monuszko, Julia Salinaro, Ashraf S Habib, J Eric Jelovsek, Laura J Havrilesky, Brittany Davidson, et al. (2022). Development and Validation of a Model for Opioid Prescribing Following Gynecological Surgery. JAMA network open, 5(7). p. e2222973. 10.1001/jamanetworkopen.2022.22973 Retrieved from https://hdl.handle.net/10161/27477.
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Brittany A Davidson
My research passion lies at the intersection of gynecologic cancers and palliative care, helping patients with GYN cancers and their families navigate the journey of their cancer diagnoses to maximize their quality of life and mitigate aggressive and futile care near the end of life. I am also passionate about how the healthcare team communicates with patients and their families. Cancer care should be patient-centered based on an individual's own values--this requires comprehensive goals of care conversations early and often throughout the cancer trajectory. This has led me to become involved in VitalTalk Communication Skills training, which I have taught both locally at Duke and across the country to clinicians in various clinical settings.
Clinically, caring for patients with gestational trophoblastic neoplasms and cancers in adolescents and young adults is a rewarding aspect of my job. Helping patients and their families navigate cancer diagnoses and the potential impact this has on growing families is rewarding. I enjoy working in a multi-disciplinary approach with our reproductive endocrinology, psychology, and cancer support teams to maximize longevity, quality of life and family building opportunities.
As the program director for the OB/GYN department, medical education and simulation is also near and dear to my heart. I find great joy in mentoring trainees at all stages and in all venues--clinically, research, and professionally.
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