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Postoperative pain management – Free Papers 7
OP067 Multimodal analgesia and outcomes after hysterectomy surgery – a population-based analysis using United States data
  1. Hannah Gerner1,
  2. Crispiana Cozowicz2,
  3. Haoyan Zhong3,
  4. Alex Illescas3,
  5. Lisa Reisinger3,
  6. Jiabin Liu3,4,
  7. Jashvant Poeran5 and
  8. Stavros Memtsoudis4,6
  1. 1Medical University of Graz, Graz, Austria
  2. 2Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
  3. 3Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA
  4. 4Department of Anesthesiology, Weill Cornell Medicine, New York, USA
  5. 5Institute for Healthcare Delivery Science, Department of Population Health Science and Policy/Department of Orthopedics/Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
  6. 6Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA

Abstract

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Background and Aims Multimodal analgesia is increasingly used in various surgeries, including in hysterectomy surgery. However, large scale comparative and outcome data are lacking. We investigated associations between multimodal analgesia use and postoperative outcomes among patients underwent hysterectomy.

Methods After Institutional Review Board approval, we identified adult patients underwent hysterectomy from the Premier Healthcare claims dataset (n= 1,307,923 from 2006-2022). Multimodal analgesia was defined as opioid use with the addition of non-opioid analgesic modalities, including non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, paracetamol, steroids, gabapentin/pregabalin, ketamine, neuraxial anesthesia, or peripheral nerve block. This was stratified into 4 categories: opioids-only, and multimodal analgesia with the addition of 1, 2 or ≥3 non-opioid analgesic modalities. Regression models measured associations between multimodal analgesia categories and postoperative complications, naloxone use (as proxy for opioid-related complication), hospital length of stay, and opioid use. We report odds ratios (OR or% change) and 95% confidence intervals (CI).

Results Overall, we found that opioids-only, and addition of 1, 2 or ≥3 non-opioid analgesic modalities represented 15.4% (n=200,904), 49.9% (n=652,872), 23.7% (n=309,334), and 11.1% (n=144,813) of patients, respectively. Opioid-only analgesic regimens decreased from 25.3% in 2006 to 5.1% in 2022 (figure 1). In multivariable models, multimodal analgesia was consistently associated with lower risk of a composite complication outcome, decreased opioid consumption, and hospital length of stay. Interestingly, multimodal analgesia was associated with higher risk of naloxone use. (Table 1)

Abstract OP067 Figure 1
Abstract OP067 Figure 1

Trend of multimodal use for hysterectomy surgery 2006-2022

View this table:
Abstract OP067 Table 1

Logistic regression models meauring associations between multimodal analgesia and postoperative complications, hospital length of stay, and opioid consumption

Conclusions Application of multimodal pain management has increased in hysterectomy surgeries coinciding with reductions in postoperative complications, reduced opioid use and shortened patient recovery.

  • Multimodal analgesia
  • hysterectomy
  • opioid consumption.

https://doi.org/10.1136/rapm-2024-ESRA.66

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