(Poster 15) Opioid Use in the Immediate Postoperative Period After Urogynecologic Surgery

Objectives: To quantify postoperative opioid use within the first seven days following urogynecologic surgery in Morphine Milligram Equivalents (MMEs).

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Studies were identified through PubMed, Web of Science, and EMBASE. Eligible studies included prospective/retrospective cohorts, RCTs, and intervention studies reporting opioid consumption for one week after surgery for pelvic organ prolapse (POP) or urinary incontinence (UI). Data were extracted and converted to morphine milligram equivalents (MMEs). Risk of bias was assessed using the Newcastle-Ottawa Scale, ROBINS-I, and the Cochrane Risk of Bias Tool. Meta-analyses were performed using random-effects models.

Results: Seventeen studies comprising 1,245 patients were included in the meta-analysis. The overall pooled mean opioid consumption within 7 days postoperatively was 40.87 MMEs (95% CI: 32.89–48.86). Patients undergoing surgery for urinary incontinence used significantly less opioids (15.94 MMEs; 95% CI: 9.43–22.45) compared to those treated for pelvic organ prolapse (45.14 MMEs; 95% CI: 35.79–54.49). Among patients undergoing POP surgery, minimally invasive approaches (laparoscopic or robotic) were associated with lower opioid use (42.07 MMEs; 95% CI: 25.59–58.54) compared to the abdominal approach (108.48 MMEs; 95% CI: –11.38–228.34), and were similar to the vaginal approach (40.80 MMEs; 95% CI: 20.85–60.75). When categorized by the procedure type, anterior-posterior vaginal repairs had the highest pooled opioid use (54.97 MMEs; 95% CI 10.94–99.00), followed by apical support procedures (38.04 MMEs; 95% CI 29.02-47.07), and mid-urethral sling procedures, which had the lowest use (18.24 MMEs; 95% CI 13.99-22.46). Substantial heterogeneity was observed across analyses (I² > 70%), though sensitivity analyses confirmed the robustness of these findings.

Conclusions: This review highlights the limited use and the significant variability of postoperative opioid consumption in women undergoing urogynecologic surgery. The findings support the development of tailored, evidence-based opioid prescribing guidelines to reduce unnecessary opioid exposure while maintaining adequate pain control.