(Poster 98) Do Prior Experiences of Sexual Violence Impact Postoperative Pain?

Objectives: History of sexual violence influences pain processing, and sexual violence is more prevalent among women. However, there is limited understanding of how history of sexual violence may influence pain control after gynecologic surgery. Our objective was to evaluate whether history of sexual violence is associated with higher morphine equivalent dose (MED) after elective, benign minimally invasive hysterectomy.

Methods: We conducted a retrospective cohort study using electronic medical records at a multi-hospital, tertiary academic healthcare system across a major metropolitan region. All adult patients who underwent minimally invasive total laparoscopic hysterectomy for elective and benign indications were captured. The following demographic, concomitant conditions, perioperative and postoperative data were abstracted from patient’s charts and verified by manual chart review: age, race, ethnicity, primary language, anxiety, chronic pain conditions, substance use, drug allergies, history of prior gynecologic surgery, use of local anesthetic during surgery, estimated blood loss, operative time, specimen weight, concurrent procedures, and MED at discharge and MED accumulated over six months postoperatively. Patients with missing key variables were excluded. Patients were categorized into two cohorts: those with history of sexual violence and those without. The two cohorts were compared using univariable analysis techniques and covariates were identified. Multivariable linear regression controlling for these covariates was performed. Hierarchical regression was performed as a supplementary analysis.

Results: A total of 753 patients were included, of whom 66 (8.76%) had a history of sexual violence. Significant differences between cohorts were observed for age, race, body mass index and history of illicit drug use. While patients with a history of sexual violence had higher mean MED at discharge (194.53 vs 139.63, p=0.08), multivariable linear regression revealed no significant association between history of sexual abuse and MED at discharge or six months postoperatively (e.g. regression coefficient for MED at discharge: 24.47 mg, 95% CI -148.03 to 99.07). However, MED at discharge and at six months were significantly associated with the following: history of illicit drug use (80.42 mg, 95% CI 4.01 to 156.83), allergy to NSAIDs (208.99 mg, 95% CI 88.60 to 329.38). Hierarchical regression analysis confirmed these findings.

Conclusions: Although patients with a history of sexual violence had higher MED at discharge following elective, benign minimally invasive hysterectomy, this association was not significant after adjusting for confounders. Higher MED was significantly associated with history of illicit drug use and NSAIDs allergy, highlighting the need for comprehensive pain management strategies in these populations. That said, further research is needed to better understand the postoperative pain management in patients with a history of sexual violence.