Presentation Authors: Mohammed Said*, Atlanta, GA, Dattaraya Patil, Kenneth Ogan, Akanksha Mehta, Christopher Filson, Aaron Lay, Atlanta , GA
Introduction: The USA is in the midst of an opioid epidemic, the scope of which is currently being elucidated. Given the widespread use of postoperative opioids, identifying patients at risk for prolonged opioid use is an important avenue for prevention. Thus, we evaluated the risk and incidence of prolonged opioid use in opioid-naÃ¯ve patients after minimally-invasive urologic surgery.
Methods: We studied insurance claims from the Truven MarketScan to identify opioid-naÃ¯ve patients, age 18-64, who underwent laparoscopic or robotic radical prostatectomy, nephrectomy, partial nephrectomy, pyeloplasty, and sacrocolpopexy between 2009 and 2015. Patients were observed for 6 months to determine the number and oral morphine equivalent (OME) dosage of postoperative opioid prescriptions. We assessed prolonged opioid use, defined as patients who filled a perioperative opioid prescription followed by a prescription between 90 and 180 days after surgery, and evaluated risk factors using logistic regression.
Results: 17,713 opioid-naÃ¯ve patients filled a perioperative prescription. Of these, 4.9% of patients continued to fill prescriptions between 90 and 180 days after surgery. In multivariate models there was no significant difference between surgery type for prolonged opioid use. Compared to a reference value of < 20th percentile, higher OME quintiles showed a significant effect. Pain and mental health disorders were associated with prolonged opioid use, OR 1.35 (1.15-1.58, p < 0.01) and OR 1.39 (1.18-1.64, p < 0.01), respectively. Other variables that were associated with prolonged opioid use include female gender, higher Charlson comorbidity index, and Southern region.
Conclusions: 4.9% of opioid-naÃ¯ve patients continue to fill opioid prescriptions 90 days after stone surgery. Surgery type was not associated with prolonged use. Receiving large doses of opioids relative to the lowest quintile was associated with prolonged use. Preoperative interventions centered on opioid alternatives and early cessation, particularly among patients at risk for long-term use, such as those with pain and mental health disorders are critical to addressing the prescription opioid crisis in the USA.