Risk factors for postoperative opioid prescription after benign hysterectomy

OBJECTIVE: To identify risk factors for dispensed opioid prescriptions after benign hysterectomy. DESIGN: A nationwide register-based cohort study including 50,601 hysterectomies with complete data from the Swedish National Quality Register for Gynecological Surgery (GynOp). Data were linked to the Swedish National Drug Register, the National Patient Register, and Statistics Sweden. Logistic regression analyses were performed in three steps: adjusting for demographics, intraoperative factors, and postoperative complications. RESULTS: Increasing age was associated with a lower risk of postoperative opioid dispensing (aRR 0.56 for >70 vs <50 years; 95% CI 0.49-0.64). Lower risk was also observed for hysterectomy due to prolapse (aRR 0.63; 95% CI 0.56-0.72) and cervical dysplasia (aRR 0.86; 95% CI 0.77-0.95). Modestly increased risks were found among patients using antihypertensive or cardiac medications (aRR 1.13; 95% CI 1.05-1.21), with previous cesarean section (aRR 1.10; 95% CI 1.05-1.16), BMI 30-39 (aRR 1.12; 95% CI 1.02-1.24), smoking (aRR 1.12; 95% CI 1.02-1.22), previous abdominal surgery (aRR 1.22; 95% CI 1.16-1.29), or previous vaginal surgery (aRR 1.15; 95% CI 1.06-1.24).Substantially increased risks were associated with preoperative psycholeptics (aRR 1.65; 95% CI 1.55-1.76), antidepressants (aRR 1.22; 95% CI 1.13-1.32), immunomodulators (aRR 1.45; 95% CI 1.11-1.90), endometriosis (aRR 1.58; 95% CI 1.36-1.83), open surgery (aRR 1.43; 95% CI 1.33-1.54), and postoperative complications (aRR 1.46; 95% CI 1.40-1.53). The strongest predictor was region: surgery in Stockholm was associated with more than double the risk (aRR 2.52). CONCLUSIONS: Postoperative opioid dispensing after benign hysterectomy is primarily driven by patient-related factors and regional prescribing practices. Despite increasing adoption of minimally invasive techniques, opioid dispensing rose by 8% annually from 2005 to 2022, underscoring the need for targeted strategies to reduce unnecessary postoperative opioid exposure.