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BACKGROUND: Given that patients undergo hysterectomy with the goal of improving different symptoms and concerns, it is important to consider whether sexual function differs prior to and following hysterectomy depending on preoperative surgical indications. Our aims were to describe characteristics of sexual function prior to and six months following benign hysterectomy in patients with three common surgical indications, and to identify preoperative factors that influence the magnitude and direction of change in sexual function after the procedure. METHODS: This prospective observational cohort study enrolled women (n=80) undergoing hysterectomy for benign indications at an academic tertiary care center between December 2015 to July 2017. Patients were categorised into three groups according to surgical indication: 1) pelvic pain (PP), 2) abnormal uterine bleeding (AUB), and 3) pelvic organ prolapse (POP). Primary outcome was Female Sexual Function Index (FSFI), which patients completed preoperatively and six months postoperatively. RESULTS: The study included 80 patients, of whom 25.0% (n=20) had surgical indication of PP, 46.3% (n=37) of AUB, and 28.7% (n=23) of POP. PP patients experienced a significant improvement in overall sexual function, as well as orgasm and pain domains following hysterectomy. Significant improvements were not found in AUB and POP patients. In multivariate analysis, lower baseline sexual function (p

OBJECTIVES/GOALS: Patients on chronic opioids face gaps in transitions of care in the time following surgery, increasing the risk for adverse events, specifically high-risk opioid prescribing. The objective of this study is to determine how rates of high-risk prescribing differ between patients with public and private insurance. METHODS/STUDY POPULATION: A retrospective cohort study of 1,435 adult patients with preoperative chronic opioid use on Medicaid or commercial insurance who underwent surgery between November 2017 and February 2021. Patients were identified using the Michigan Surgical Quality Collaborative (MSQC) database, a collection of perioperative data from 70 hospitals across the state of Michigan. Data from the MSQC were merged with Michigan’s prescription drug monitoring program to provide additional information on pre- and postoperative opioid prescribing. Multivariable logistic regression was used to assess high-risk prescribing by the presence of a preoperative usual prescriber and insurance type. RESULTS/ANTICIPATED RESULTS: Overall, 22.7% of patients on private insurance and 23.6% of patients on Medicaid fulfilled criteria for new, postoperative high-risk prescribing. Among criteria for high-risk prescribing, multiple prescribers was the most significant contributor (private insurance: 17.4%, Medicaid: 18.9%). Patients on Medicaid insurance did not have increased odds of new postoperative high-risk prescribing (OR = 1.067, 95% CI: 0.813-1.402). While fewer patients on Medicaid had a preoperative usual prescriber (86.9% and 90.9% respectively, p = 0.015), there was no significant difference between the two insurance types in baseline rates of high-risk prescribing prior to surgery (private insurance: 43.4%, Medicaid: 46.0%, p = 0.352). DISCUSSION/SIGNIFICANCE: While we do not observe disparities in high-risk prescribing between insurance types, rates of high-risk prescribing postoperatively are high across payer types. Further studies to determine the factors driving rates of high-risk opioid prescribing among patients with chronic opioid use are needed to identify areas for future intervention.

Introduction:We summarize the 2018 AUA (American Urological Association) Quality Improvement Summit, Opioid Stewardship in Urology, highlighting appropriate urological opioid use as well as...

The Opioid Prescribing Engagement Network (OPEN) at the University of Michigan was established in 2016 with the goal of reducing excessive opioid prescribing after surgery using evidence-based prescribing guidelines. Beginning in July 2016, OPEN began a statewide quality improvement campaign to educate providers and share prescribing best practices. In October 2017, the first prescribing guidelines were released. Although these efforts have been associated with significant decreases in postoperative opioid prescribing, it is unknown whether the incidence of new persistent opioid use after surgery has changed as well. This retrospective study examines the effect of these efforts on new persistent opioid use after surgery compared to the rest of the United States - including other states where no such program existed - using a difference-in-differences approach.

Pain is the most common symptom of cerebral palsy and spina bifida (CP/SB). The objective of this study was to compare the opioid prescription patterns for differing pain types and overlapping pain among adults living with and without CP/SB.Privately-insured beneficiaries were included if they had CP/SB (n = 22,647). Adults without CP/SB were also included as controls (n = 931,528). Oral morphine equivalents (OMEs) were calculated. A multivariable logistic regression was used to analyze the association between CP/SB and OMEs, across the three pain categories: (1) no pain, (2) isolated pain, and (3) pain multimorbidity.Adults living with CP/SB had a higher OME prescription pattern per year than adults without CP or SB (8,981.0 ± 5,183.0 vs. 4,549.1 ± 2,988.0), and for no pain (4,010.8 ± 828.1 vs. 1,623.53 ± 47.5), isolated pain (7,179.9 ± 378.8 vs. 3,531.0 ± 131.0), and pain multimorbidity (15,752.4 ± 1,395.5 vs. 8,492.9 ± 398.0) (all p0.001), and differences were to a clinically meaningful extent. Adjusted odds ratios (OR) for prescribed OMEs were higher for adults with CP/SB vs. control and (1) no pain (OR: 1.51; 95%CI: 1.46, 1.56), (2) isolated pain (OR: 1.48; 95%CI: 1.44, 1.52), and (3) pain multimorbidity (OR: 1.79; 95%CI: 1.72, 1.86).Adults with CP/SB obtain significantly higher prescription of OMEs than adults without CP/SB.

IMPACT: This is the first examination of risk factors for prolonged opioid use after an ICU stay and will inform efforts to strengthen prescribing guidelines and care transition models for patients after critical illness. OBJECTIVES/GOALS: The majority of patients in intensive care units (ICU) receive opioids during admission, and up to 25% receive a prescription at discharge. However, transitions of care and prolonged use after discharge remain unknown. We aim to characterize risk factors for prolonged opioid use after an ICU stay. METHODS/STUDY POPULATION: A retrospective study using insurance claims from Optum Clinformatics ®Data Mart was conducted for opioid-naive adult patients (18-64 years) with an ICU admission from 2010 to 2019. The primary outcome was new persistent opioid use, defined as a continued prescription fill 91-180 days after discharge, in addition to a fill in the first 90 days. The primary exposure was an opioid fill at discharge. The ICU admission was characterized using the Clinical Classification System from the Agency of Healthcare Research and Quality, based on patients’primary diagnosis code. Diagnoses were combined into 11 groups highlighting the affected organ system/mechanism of injury. Logistic regression evaluated the associations of patient demographic and clinical characteristics with the probability of persistent opioid use. RESULTS/ANTICIPATED RESULTS: In this cohort of 90,721 patients discharged from the ICU, 3.3% continued to fill opioids at 6 months. An opioid prescription fill (OR 3.1; 95% CI 28 - 3.3) and benzodiazepine prescription fill (OR 1.6; 95% CI 1.4 - 1.8) within 3 days of ICU discharge were each significantly associated with the development of new persistent opioid use. Patient diagnosis groups of Musculoskeletal/Trauma (OR 2.3; 95% CI 2.0 - 2.6), Neoplasms (OR 1.6; 95% CI 1.5 - 1.9), and GI/Hepatobiliary (OR 1.5; 95% CI 1.3 - 1.8) were significantly more likely to develop new persistent use when compared to the Cardiovascular diagnosis group. DISCUSSION/SIGNIFICANCE OF FINDINGS: Opioid prescriptions at discharge after an ICU stay increase the odds of prolonged opioid use. These results will inform efforts to strengthen prescribing guidelines and care models after a critical illness. Further work will characterize the trajectory of prescribing and patient exposure to high-risk prescribing after ICU discharge.

The United States faces a crisis due to the high prevalence of chronic pain and associated opioid use disorder and overdose deaths. While the majority of acute pain resolves within weeks, 20-50% of people with acute pain persists well beyond the initial insult. The mechanisms driving the transition from acute to chronic pain states are poorly understood. Through a National Institutes of Health (NIH)-funded initiative, the A2CPS Program was formed to identify putative biomarkers (individual or biosignature combinations) that predict susceptibility or resilience for the transition from acute to chronic pain after surgery (total knee replacement and thoracotomy). The A2CPS consortium includes two multisite clinical centers (MCCs), one Clinical Coordinating Center (CCC), one Data Integrations and Research Center (DIRC), and 3 OMICS centers along with representation from the NIH Pain Consortium, Common Fund, and National Institute of Drug Abuse. During an initial planning year, the A2CPS developed study aims, biomarker selection, and a study protocol. Candidate biomarkers were selected across multiple domains (clinical, biospecimen, psychosocial, and brain structure/function). Data will be collected from two MCCs (n=3600 individuals) before, during and after surgery to determine factors that predict the transition from acute to chronic pain 6 months later. Subjects will be comprehensively phenotyped across measures of pain, behavioral and psychological, quantitative sensory testing, brain imaging, proteomics, genomics, metabolomics, and lipidomics. Determining biomarkers prior to and in the acute phase after surgery could provide the basis for interventions to prevent the onset of chronic pain and contribute to our understanding of the dynamic processes underlying the transition from acute to chronic pain. Furthermore, if any of the predictive biomarkers play a mechanistic role in development of chronic pain, then the molecules, pathways, constructs, and/or brain circuits identified could serve as new potential therapeutic targets for reversing chronic pain or increasing patients’ resilience. National Institutes of Health Grants: NS112873, NS118922, DA049110, NS112874, DA049115, DA049116, DA049113.

Fibromyalgia is the prototypical centralized pain disorder with an estimated prevalence between 2% and 8%. Despite the controversy in the medical community, more is known about the mechanisms driving the pain and symptoms, as well as the appropriate treatment, than other pain conditions. It is characterized by widespread body pain and can be accompanied by a number of comorbid symptoms, including headache and trouble thinking. Fibromyalgia is associated with a number of changes to the central nervous system, including higher levels of neurotransmitters that increase pain (e.g., glutamate, Substance P) and lower levels of neurotransmitters that downregulate pain (e.g., GABA). Fibromyalgia patients have a paradoxical increase in endogenous opioid levels in the central nervous system, which is thought to explain the nonresponsiveness to exogenous opioids for acute and chronic pain. Given the known changes to the central nervous system, peripherally directed treatments, such as injections or surgeries, are less successful. Treatments should be directed to the known CNS pathology (serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, gabapentinoids). Furthermore, behavioral therapies are effective to address some of the affective symptoms and to encourage patients to incorporate exercise and other self-directed therapies. With appropriate treatment, patients with fibromyalgia can experience reduced pain and increased function.