Multimodal analgesia and outcomes after hysterectomy surgery – a population-based analysis using United States data

Multimodal analgesia is increasingly used in various surgeries, including in hysterectomy surgery. However, large scale comparative and outcome data are lacking. We investigated associations between multimodal analgesia use and postoperative outcomes among patients underwent hysterectomy.

After Institutional Review Board approval, we identified adult patients underwent hysterectomy from the Premier Healthcare claims dataset (n= 1,307,923 from 2006-2022). Multimodal analgesia was defined as opioid use with the addition of non-opioid analgesic modalities, including non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, paracetamol, steroids, gabapentin/pregabalin, ketamine, neuraxial anesthesia, or peripheral nerve block. This was stratified into 4 categories: opioids-only, and multimodal analgesia with the addition of 1, 2 or ≥3 non-opioid analgesic modalities. Regression models measured associations between multimodal analgesia categories and postoperative complications, naloxone use (as proxy for opioid-related complication), hospital length of stay, and opioid use. We report odds ratios (OR or % change) and 95% confidence intervals (CI).

Overall, we found that opioids-only, and addition of 1, 2 or ≥3 non-opioid analgesic modalities represented 15.4% (n=200,904), 49.9% (n=652,872), 23.7% (n=309,334), and 11.1% (n=144,813) of patients, respectively. Opioid-only analgesic regimens decreased from 25.3% in 2006 to 5.1% in 2022 (Figure 1). In multivariable models, multimodal analgesia was consistently associated with lower risk of a composite complication outcome, decreased opioid consumption, and hospital length of stay. Interestingly, multimodal analgesia was associated with higher risk of naloxone use. (Table 1)

Application of multimodal pain management has increased in hysterectomy surgeries coinciding with reductions in postoperative complications, reduced opioid use and shortened patient recovery.