Opioid Use After Robotic Assisted versus Laparoscopic Endometriosis Surgery

BACKGROUND AND OBJECTIVE: Minimally invasive endometriosis surgery can be done laparoscopically or with robotic assistance. The choice of modality of this procedure could impact postprocedure pain levels and the need for opioids to manage pain. The objective of this study is to evaluate differences in opioid prescription fill rates following endometriosis surgery between robotic-assisted and laparoscopic approaches. METHODS: A retrospective cohort study using the Merative MarketScan (United States employer-based claims database) from 2016 to 2021. Opioid prescription fills were examined in three time periods: preoperative (12 months to 30 days before surgery), perioperative (29 days before to 14 days after), and postoperative (15 days to 24 months after). Logistic regression models estimated average marginal effects (AME) for perioperative and postoperative opioid use, adjusting for demographics, health conditions, concomitant procedures, and prior opioid use. RESULTS: Of the 28,088 individuals who underwent endometriosis surgery, 6.24% (1,752 patients) had robotic-assisted procedures. In the postoperative period, laparoscopic surgery was associated with a higher probability of postoperative opioid prescription fills compared to robotic-assisted surgery (adjusted AME = 3.2; 95% CI: 0.7, 5.7; P ≤ .01). Among patients with baseline pain disorders, robotic-assisted surgery was associated with lower postoperative opioid prescription fills (adjusted AME = 3.2; 95% CI: 0.2, 6.2; P = .04). CONCLUSIONS: Robotic-assisted procedures were associated with a reduced likelihood of opioid prescription fills in the postoperative period following surgery compared to laparoscopic procedures, including for patients with baseline pain disorders.