INPATIENT AND POST-DISCHARGE NARCOTIC UTILIZATION FOR PATIENTS UNDERGOING PENILE INVERSION VAGINOPLASTY IN AN URBAN SAFETY-NET HOSPITAL PROGRAM
Recent literature has established that younger age, higher rates of pre-operative mental health diagnoses, pre-operative substance use, and physician prescribing practices are risk factors for persistent post-operative narcotic use. We sought to recognize our patient population’s unique exposure to these risk factors and to exercise careful and judicious use of narcotics during surgical recovery after vaginoplasty for gender affirming surgery. The objective of this study is to measure perioperative narcotic use in patients undergoing vaginoplasty, determine baseline usage rates, and determine the feasibility of our strategy of minimal necessary narcotic usage.
We conducted a quality improvement review of patients who underwent vaginoplasty at Denver Health Medical Center from May 1, 2018 to February 28, 2019. Records were reviewed for in-hospital narcotic usage and discharge prescription data. The Physician Drug Monitoring Program (PDMP) was used to expand prescription refill information. Descriptive statistics were calculated.
During the study period, 40 patients underwent vaginoplasty. Median age was 32 years, median follow-up was 42 days, and median BMI was 27. Median inpatient MME consumption was 156 with an interquartile range (IQR) of 73-232. 13 patients (32.5%) required intravenous narcotics while inpatient, the remainder had their pain well controlled with oral medications. All patients were discharged with a prescription for oxycodone 5mg tablets, the median number of tablets prescribed was 20 (IQR 15-30). Overall, 9 patients (22%) had their narcotic prescription refilled after discharge. Of those getting refills, three received one refill, five received two refills, and one received four refills. The minimum number of tablets dispensed on discharge was ten; five patients received that amount, none of whom received a refill. Three patients (7.5%) had pre-operative narcotic use, of whom one (33%) had their narcotic prescription refilled after discharge.
Overall this data shows that judicious narcotic usage following this surgery is safe and feasible. There is little data in the literature regarding narcotic utilization following vaginoplasty. Future directions include further refining and formalizing our narcotic prescribing practices and pathways. Additionally we will seek to follow our patients long-term to ensure that the risk of persistent post-operative narcotic use is minimized.
narcotic use; vaginoplasty; postoperative pain
Trauma / Uretra / Urologia Reconstrutora
Denver Health - - Estados Unidos, University of Colorado - - Estados Unidos
Rodrigo Donalisio da Silva, Matheus Miranda Paiva, Fernando J Kim