Low Versus Standard Opioid Prescriptions Following Urogynecologic Procedures: Impact on Healthcare Utilization

INTRODUCTION: Opioids have traditionally played a central role in managing postoperative pain, although their use carries significant risks. Implementation of Enhanced Recovery after Surgery (ERAS) protocols aims to minimize opioid use as a part of optimizing patient’s recovery. Amid the ongoing opioid epidemic in the United States, there is a heightened focus on reducing opioid prescriptions. There is limited literature in urogynecology on the impact of opioid prescribing rates on postoperative clinical burden, particularly patient messaging through the electronic medical record. OBJECTIVE: The primary objective was to determine the impact of low versus standard opioid prescriptions on utilization of health care services within 30 days of surgery, including patient portal messages, telephone calls, unscheduled office visits, and emergency room visits. The secondary objective was to evaluate opioid refill rates between the groups. METHODS: We performed a single-center retrospective cohort study of patients undergoing major and minor urogynecologic procedures between April 2024 and March 2025, following the implementation of an ERAS protocol. Low opioid prescriptions were defined as 5 pills of any opioid, or less, and standard prescriptions as 6 pills, or more prescribed at discharge. Group differences were assessed using Wilcoxon rank sum tests for continuous variables and Fisher's exact tests for categorical variables. RESULTS: Of 252 urogynecologic surgery patients, 126 were prescribed a low opioid dose (mean 1.3 pills) and 126 received a standard dose (mean 9.6 pills). 159 patients (63.1%) underwent an apical suspension with 77 (48.4%) receiving low vs 82 (51.6%) standard opioid prescription. 93 patients underwent a minor procedure with 49 (52.7%) receiving low vs 44 (47.3%) standard opioid prescription. There was no difference in age (mean 69.4 vs 62.3), route of surgery, total morphine milligram equivalents (MME) of opioids given during hospitalization (9 vs 12.5, p=0.74), or last pain score (1.8 vs 1.8, p=0.66), and the number of opioids prescribed on discharge (Table 1). There was no difference in total number of contact points with the healthcare system for pain or constipation between low vs standard opioid prescription recipients (mean, 1.9 vs 1.9). There was no difference in number of patients who had any contact with the hospital system for pain or constipation (42.1% vs 43.7%), patient portal messages (22.2% vs 19.0%), telephone calls (31.7% vs 31.7%), or unscheduled office visits (6.3% vs 7.1%). A similar number of opioid prescription refills were sent for those who received low vs standard number of opioid pills on discharge (8.7% vs 13.5%). CONCLUSIONS: Prescribing a low number of opioids following urogynecologic procedures while utilizing a multimodal pain approach with an ERAS protocol did not lead to higher postoperative patient utilization of healthcare services. Patients also did not request opioid refill prescriptions more often if discharged with a low number of opioids.Table 1