Perioperative Opioid Use in Urogynecologic Mesh Removal

Abstract

Importance: Forty percent of patients with urogynecologic mesh pain complications are taking narcotics.

Objectives: We aimed to compare comorbidities and pain scores between patients with and without narcotic use and assess postoperative narcotic use rates.

Study design: This was a secondary analysis of a prospective cohort study of patients undergoing urogynecologic mesh removal. Patients with mesh removal for pain within 7 years were included due to data availability. Narcotic prescriptions were verified using the Pennsylvania Prescription Drug Monitoring Program. Pain scores were assessed at baseline and 6-24 months postoperatively.

Results: Of 139 patients, 30 (21.6%) filled narcotic prescriptions within 3 months preceding surgery. These patients were younger and more likely to have a chronic pain condition. Narcotic use did not differ by sling versus prolapse mesh, or presence of exposure. Patients taking preoperative narcotics had a 27-point higher median baseline visual analog scale pelvic pain score (P = 0.01). Patients with pain comorbidities had 6 times odds of using preoperative narcotics. Younger patients had less improvement in pelvic pain after removal. Only 8 (27%) of those taking narcotics discontinued use postoperatively with no significant predictors of prolonged (≥3 months) use. Eighty-seven percent of patients with prolonged postoperative use had a prior pain diagnosis, commonly joint and back pain.

Conclusions: In patients with mesh-related pain, those with chronic pain conditions had much higher odds of taking preoperative narcotics, and in most, mesh removal did not eliminate narcotic use. Counseling is warranted in patients with chronic pain conditions that pain and narcotic use are likely to persist after removal.