Abstract:
OBJECTIVE:To quantify physician prescribing patterns and patient opioid use in the 2 weeks after hysterectomy at an academic institution and to determine whether patient factors predict postsurgical opioid use and pain recovery. METHODS:We conducted a prospective quality initiative study by recruiting all English-speaking patients undergoing hysterectomy for benign, nonobstetric indications at a university hospital between August 2015 and December 2015, excluding those with major medical morbidities or substance abuse. Before hysterectomy, patients completed the Fibromyalgia Survey, a validated measure of centralized pain. After hysterectomy, opioid use (converted to oral morphine equivalents) and pain scores (0-10 numeric rating scale) were collected by a daily diary and a structured telephone interview 14 days after surgery. Primary outcomes were total opioid prescribed and consumed in the 2 weeks after hysterectomy. Secondary outcomes included daily opioid use and daily pain severity for 14 days after hysterectomy. RESULTS:Of 103 eligible patients, 102 (99%) agreed to participate, including 44 (43.1%) laparoscopic, 42 (41.2%) vaginal, and 16 (15.7%) abdominal hysterectomies. Telephone surveys were completed on 89 (87%) participants; diaries were returned from 60 (59%) participants. Diary nonresponders had different baseline characteristics than nonresponders. Median amount of opioid prescribed was 200 oral morphine equivalents (interquartile range 150-250). Patients reported using approximately half of the opioids prescribed with a median excess of 110 morphine equivalents (interquartile range 40-150). The best fit model of total opioid consumption identified preoperative Fibromyalgia Survey Score, overall body pain, preoperative opioid use, prior endometriosis, abdominal hysterectomy (compared with laparoscopic), and uterine weight as significant predictors. Highest tertile of Fibromyalgia Survey Score was associated with greater daily opioid consumption (13.9 [95% CI 3.0-24.8] greater oral morphine equivalents at baseline, P=.02). CONCLUSION:Gynecologists at a large academic medical center prescribe twice the amount of opioids than the average patient uses after hysterectomy. A personalized approach to prescribing opioids for postoperative pain should be considered.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
As-Sanie S,Till SR,Mowers EL,Lim CS,Skinner BD,Fritsch L,Tsodikov A,Dalton VK,Clauw DJ,Brummett CMdoi
10.1097/AOG.0000000000002344subject
Has Abstractpub_date
2017-12-01 00:00:00pages
1261-1268issue
6eissn
0029-7844issn
1873-233Xpii
00006250-201712000-00011journal_volume
130pub_type
杂志文章abstract::Previous reports have implicated the Dalkon shield intrauterine device (IUD) in septic second trimester abortion and maternal death from sepsis. In the case reported here, Fusobacterium necrophorum, a rarely pathogenic vaginal anaerobe, gained access to the uterus in a woman wearing a Dalkon shield and caused acute pa...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-09-01 00:00:00
abstract:OBJECTIVE:To investigate trends in the incidence of shoulder dystocia, methods used to overcome the obstruction, and rates of maternal and neonatal morbidity. METHODS:Cases of shoulder dystocia and of neonatal brachial plexus injury occurring from 1991 to 2005 in our unit were identified. The obstetric notes of cases ...
journal_title:Obstetrics and gynecology
pub_type: 评论,杂志文章
doi:10.1097/01.AOG.0000287615.35425.5c
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVE:To determine the effect of patient position on the mobility of the urethrovesical junction. METHODS:Q-tip tests in the supine and standing positions were performed on forty-six consecutive female patients with a variety of urogynecologic complaints. Wilcoxon signed-rank test and McNemar test were used to com...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)93705-5
更新日期:1995-08-01 00:00:00
abstract:OBJECTIVE:To estimate the relationship between hormonal parameters of diminished ovarian reserve and the incidence of aneuploid blastocysts. METHODS:This prospective cohort trial was performed in a private in vitro fertilization clinic. Three hundred seventy-two patients underwent in vitro fertilization with blastocys...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/aog.0b013e318278eeda
更新日期:2013-01-01 00:00:00
abstract::The balance between relaxin and prolactin has been suggested to be significant in the control of uterine activity during pregnancy. The current study was designed to determine the effect of rat prolactin on rat uterine horn segment contractility and its interaction with relaxin. Rat uterine segments mounted on a smoot...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1984-07-01 00:00:00
abstract::Although surgical management of symptomatic pelvic organ prolapse (POP) is common and often necessary, conservative treatments such as pessaries, pelvic floor muscle training, or both can usually result in symptomatic improvement. When treating patients with POP, health care practitioners should focus primarily on ide...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0b013e31824c0806
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:To compare the expression of Cyr61 in normal cycling endometrium with endometrium from women with polycystic ovarian syndrome (PCOS) and endometrial hyperplasia and adenocarcinoma. METHODS:This is a retrospective study of 59 samples of normal and abnormal endometrium. Endometrial biopsies were obtained from ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000269047.46078.28
更新日期:2007-07-01 00:00:00
abstract::A series of 117 patients with stage I squamous cell carcinoma of the vulva was followed for 3 to 21 years. Twenty recurrences (17.1%) were found, 12 in the vulva or vagina, 7 in the groin, and 1 in a patient who developed distant metastases. Invasion of tumor cells in lymph or blood vessels was found in operative spec...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-01-01 00:00:00
abstract:OBJECTIVE:To examine the results of a quality-improvement study that implemented an enhanced recovery after surgery (ERAS) program for cesarean delivery. METHODS:A pre-post design was used to assess changes in opioid use, length of stay, and costs among all patients undergoing cesarean delivery before and after implem...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000004023
更新日期:2020-10-01 00:00:00
abstract::A retrospective review of placental material derived primarily from preterm deliveries was conducted and inflammatory changes graded on a scale of 0-3. Reviewers were blind as to the clinical outcomes. Other reviewers, unaware of the pathologic results, surveyed the clinical data, and results were combined for analysi...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-12-01 00:00:00
abstract::Ultrasound methods for detecting fetal life during early pregnancy are reviewed. By using recently developed techniques, fetal heart function can be detected as early as the 44th to 45th day of amenorrhea. Fetal movements in the amniotic cavity can be visualized from the 10th week on. If no signs of fetal life can be ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1975-11-01 00:00:00
abstract::Ten gravidas with bacteriuria in the immediate antepartum period subsequently delivered vaginally and did not receive antibiotic therapy. Four of these women developed postpartum endometritis and in three of them, the same Enterobacteriaceae recovered from the urine was present in the endometrial cultures. Of the 1233...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1991-08-01 00:00:00
abstract:OBJECTIVE:To generate estimates of the association between markers of ovarian aging and natural fertility in a community sample at risk for ovarian aging. METHODS:Women aged 30-44 years with no history of infertility who had been trying to conceive for less than 3 months provided early-follicular phase serum and urine...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182116bc8
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVE:To analyze the relation between tensile strength and levels of matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2 at a number of sites in human fetal membranes. METHODS:Tensile strengths of fetal membranes from five women who delivered vaginally a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(00)00811-5
更新日期:2000-06-01 00:00:00
abstract::During the 1970s in the United States, the number of hospitalizations for ectopic pregnancy increased more than twofold, and ectopic pregnancy emerged as a leading cause of maternal mortality. All known deaths from ectopic pregnancy in the United States from January 1, 1979, to December 31, 1980, were investigated by ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198309000-00014
更新日期:1983-09-01 00:00:00
abstract:OBJECTIVE:To compare resistance index (RI) and pulsatility index (PI) in the spiral and intervillous arteries, and peak systolic velocity of the continuous intervillous flow in normal and abnormal first-trimester pregnancy. METHODS:Transvaginal color and pulsed Doppler were used in a prospective analysis of 60 normal ...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/S0029-7844(96)00422-X
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVES:To estimate, from the literature, when nonlactating postpartum women regain fertility. DATA SOURCES:We searched PubMed and Cochrane Library databases for all articles (in all languages) published in peer-reviewed journals from database inception through May 2010 for evidence related to the return of ovulati...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0b013e31820ce18c
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Bernard-Soulier syndrome, a lack of glycoprotein IB/IX, is a rare autosomal recessive bleeding disorder characterized by platelet dysfunction. Women with Bernard-Soulier syndrome are at risk of being immunized against glycoprotein IB/IX, leading to severe isoimmune neonatal thrombocytopenia. CASE:A 26-year-...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(99)00253-7
更新日期:1999-11-01 00:00:00
abstract:BACKGROUND:The combination of severe uterovaginal prolapse and stress urinary incontinence in medically compromised patients in whom surgery is contraindicated is a difficult treatment dilemma. CASE:A 75-year-old woman with severe cardiac compromise and a history of pulmonary embolus presented with severe uterovaginal...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(97)00260-3
更新日期:1997-10-01 00:00:00
abstract::A retrospective study of 51 thecomas and granulosa-theca cell tumors of the ovary seen at Confederate Memorial Medical Center in Shreveport, Louisiana, is presented. Endometrial tissue was available for study in 38 of the 51 patients. The relation of these tumors to endometrial morphology suggests an excessive estroge...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1977-07-01 00:00:00
abstract:OBJECTIVE:Many U.S. health care providers remain reluctant to prescribe intrauterine devices (IUDs) to teenagers as a result of concerns about serious complications. This study examined whether 15-19-year-old IUD users were more likely to experience complications, failure, or early discontinuation than adult users aged...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31828b63a0
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVE:To identify the top-rated pregnancy wheel applications (apps) using a newly developed APPLICATIONS scoring system. METHODS:A list of pregnancy wheel apps was identified. Consumer-based and inaccurate apps were excluded. The APPLICATIONS scoring system was developed to rate the remaining apps. Application com...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000842
更新日期:2015-06-01 00:00:00
abstract::Adenocarcinoma of the vagina is an uncommon tumor. Many theories have been postulated for its etiology and tissue origin. Its occurrence in young women exposed in utero to diethylstilbestrol has pointed to estrogen influence as a possible etiologic factor. A case of adenocarcinoma of the vagina in a patient with gonad...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1979-03-01 00:00:00
abstract::The hemodynamic effects of intravenously infused dihydralazine (incremental doses up to 125 micrograms per minute during 60 minutes) were studied in ten women with acute or superimposed severe preeclampsia. The intervillous and umbilical vein blood flow were measured before and during dihydralazine infusion with 133Xe...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract::The pregnancy of a woman with Friedreich ataxia was complicated by the onset of preterm labor and preeclampsia. Administration of magnesium sulfate (MgSO4.7H2O) in the usual intravenous dosage resulted in the dramatic development of profound motor weakness and respiratory distress. Magnesium acts to antagonize the act...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-11-01 00:00:00
abstract::To determine whether planned anterior vaginotomy is a logical and safe means of avoiding a uterine scar with term abdominal delivery. I recorded the complications of the technique and whether vaginal birth after anterior vaginotomy occurred. Thirteen anterior vaginotomies were done when the vagina had advanced during ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(96)00209-8
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVE:To use magnetic resonance images of living women and 3-dimensional modeling software to identify the component parts and characteristic features of the external anal sphincter (EAS) that have visible separation or varying origins and insertions. METHODS:Detailed structural analysis of anal sphincter anatomy ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000189084.82449.fc
更新日期:2005-12-01 00:00:00
abstract::The histologic diagnoses of premalignant and malignant lesions of the cervix obtained by examining the colposcopically directed biopsy material from 643 patients were compared with those of the surgical material subsequently obtained. The procedures during which samples were acquired included hysterectomy (370), cervi...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-08-01 00:00:00
abstract::Fifteen women weighing more than 250 pounds (113.6 kg) underwent laparoscopy. The open technique was used in two patients electively because of repeated pelvic laparotomies through periumbilical incisions. Of the remainder, four had used the closed technique and in nine it was necessary to adopt an open technique. Use...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVE:To assess changes in the prescribing practices, knowledge, attitudes, and perceptions of health care providers after an educational program about emergency contraception. METHODS:Health care providers completed self-administered questionnaires before and 1 year after full implementation of the project. The 1...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(01)01365-5
更新日期:2001-06-01 00:00:00