Resident Physician University of California, San Francisco San Francisco, California, United States
Introduction: The CDC has declared a US opioid overdose epidemic. There are several efforts aimed to reduce physician opioid prescriptions. Studies demonstrate greater pain sensitivity and increased chronic pain states in women. While men are more likely to suffer from opioid overdoses, population studies have demonstrated that women are twice as likely to be prescribed opioids. This retrospective study aims to elucidate gender differences in postoperative opioid usage in neurosurgical patients.
Methods: 7,433 opioid-naïve adult patients undergoing a neurosurgical intervention (cranial or spine) at our quaternary care institution from June 2012 to December 2019 were included. Oral morphine equivalents (OMEs) are a standardized measure of opioid dosing used at our institution to uniformly compare inpatient and outpatient opioid doses. Pre-discharge OMEs were compared between males and females to determine possible differences in opioid requirements between the gender groups.
Results: Of 8,704 patients in our overall cohort, female patients utilized higher doses of opioids in the 24 hours prior to discharge (30 vs. 24 OME, p = 0.025), but were discharged with similar doses of opioid medications (p = 0.333). Regardless of gender, patients who underwent cranial procedures used fewer opioid medications in inpatient and outpatient settings compared to those undergoing spinal procedures (p < 0.001). Women had higher inpatient postoperative opioid use after neurosurgery (30 vs. 24 OMEs, p=0.025). However, upon discharge, there was no difference in median discharge daily opioid dose (p = 0.333). In a univariate regression analysis, female gender was not independently associated with outpatient opioid prescription refills (p=0.373).
Conclusion : This study demonstrates higher inpatient opioid usage in women after neurosurgery; however, this difference does not persist beyond the acute postoperative period. Neurosurgeons are amongst the highest prescribers of opioids in the US and are therefore in a unique position of identifying vulnerable populations and adapting patient-centric postoperative pain medication regimens.
