Presentation Authors: Jeffrey L. Ellis*, Matthew Nitti, Eric Ghiraldi, Karthik Devarajan, Justin I. Friedlander, Serge Ginzburg, Steve Sterious, Joshua A. Cohn, Erin Ohmann, Philip Abbosh, Robert Uzzo, Jay Simhan, Philadelphia, PA
Introduction: The opioid epidemic is a public health threat in the United States. Although there have been numerous studies to suggest the deleterious long term effect of overprescribing opioids in the acute postoperative period, no series have rigorously assessed prescribing patterns in urologic surgery patients following discharge. Here, we assess prescribing and refilling trends of opioid narcotics in those undergoing urologic surgery at our institution
Methods: We reviewed all urologic operative cases at our academic medical center from May 2017-April 2018. Demographic data, comorbidities, and perioperative pain management strategies were recorded and analyzed. All narcotics utilized following surgery were tabulated and reported in total morphine equivalents (TME, mg). Upon discharge from the hospital, patients were instructed to contact the Urology office for any postoperative issue following discharge, including persistent postoperative pain. A mandatory statewide narcotics utilization registry was queried for each patient to assess postoperative narcotics prescriptions along with refill data. Logistic regression analyses assessed independent predictors of those at risk of obtaining a narcotic refill following urologic surgery.
Results: Of 820 cases (median age 59, median discharge TME 30mg), 30.1% (median age 56, IQR 45-66) of the cohort required a narcotic refill following discharge (median TME 32 mg, IQR 20-59 mg). Urologists (U) were responsible for 47% of refills while primary care physicians (PCPs) were responsible for 37% despite all patients being actively followed by their surgeon. Procedure types with the highest rates of post-operative refills were male reconstruction/trauma (32%, MRT) followed by neurourology/female reconstruction (29%, NFR)(Figure 1). Patients were more likely to have a narcotic prescription refilled if they had diabetes (OR 1.48, p=0.02), a history of tobacco use (OR 1.48, p=0.01), or a history of illicit drug use (OR 1.61, p=0.02).
Conclusions: Many postoperative urology patients receive prescription refills from their PCPs, often unbeknownst to their prescribing surgeon. Although managing appropriate patient expectations regarding postoperative pain is gaining traction, creative methods to track opioid prescriptions might be necessary in an effort to combat the opioid crisis.