European journal of obstetrics, gynecology, and reproductive biology · 2025
Impact of sexual violence history on postoperative opioid use following minimally invasive hysterectomy.
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Prakash Jaya, Yang Emily, Namazi Golnaz, Kim Edward
Аннотация
OBJECTIVE: To evaluate whether a history of sexual violence is associated with differences in postoperative opioid use following laparoscopic hysterectomy for benign, non-pain-related, indications.
DESIGN: Retrospective cohort study.
SETTING: Multisite academic health system in a large metropolitan region.
PATIENTS: A total of 753 adult patients who underwent elective minimally invasive laparoscopic hysterectomy from 2013 to 2023, among whom 66 (8.8 %) had a documented history of sexual violence Patients were stratified by history of sexual violence. Demographics, perioperative variables and postoperative morphine equivalent dose (MED) were compared.
INTERVENTIONS: None.
RESULTS: Patients with a history of sexual violence had higher mean MED at discharge (194.5 vs 13.96 mg, p = 0.08) and at six months (511.3 vs 127.9 mg, p = 0.10), although these differences were not statistically significant after adjustment. In multivariable analysis, non-steroidal anti-inflammatory drug allergy or intolerance (β = 208.9; 95 % CI, 88.6-329.4) and history of illicit substance use (β = 80.4; 95 % CI, 4.0-156.8) were independently associated with increased postoperative opioid use.
CONCLUSIONS: A history of sexual violence was associated with a trend towards increased postoperative opioid use but was not an independent predictor after adjustment. Non-steroidal anti-inflammatory allergy or intolerance and history of illicit substance use were the strongest predictors of increased opioid use. These findings support the need for trauma-informed postoperative care in gynecologic surgery.
DESIGN: Retrospective cohort study.
SETTING: Multisite academic health system in a large metropolitan region.
PATIENTS: A total of 753 adult patients who underwent elective minimally invasive laparoscopic hysterectomy from 2013 to 2023, among whom 66 (8.8 %) had a documented history of sexual violence Patients were stratified by history of sexual violence. Demographics, perioperative variables and postoperative morphine equivalent dose (MED) were compared.
INTERVENTIONS: None.
RESULTS: Patients with a history of sexual violence had higher mean MED at discharge (194.5 vs 13.96 mg, p = 0.08) and at six months (511.3 vs 127.9 mg, p = 0.10), although these differences were not statistically significant after adjustment. In multivariable analysis, non-steroidal anti-inflammatory drug allergy or intolerance (β = 208.9; 95 % CI, 88.6-329.4) and history of illicit substance use (β = 80.4; 95 % CI, 4.0-156.8) were independently associated with increased postoperative opioid use.
CONCLUSIONS: A history of sexual violence was associated with a trend towards increased postoperative opioid use but was not an independent predictor after adjustment. Non-steroidal anti-inflammatory allergy or intolerance and history of illicit substance use were the strongest predictors of increased opioid use. These findings support the need for trauma-informed postoperative care in gynecologic surgery.