Presentation Authors: Mohammed Said*, Atlanta, GA, Nourhan Ismaeel, Dattaraya Patil, Kenneth Ogan, Akanksha Mehta, Christopher Filson, Aaron Lay, Atlanta , GA
Introduction: Recent studies have shown that opioid prescribing in the postoperative setting remains a significant source of opioids in the community. More specifically, they have demonstrated that there is considerable variability in the amount prescribed after routine procedures and that patients generally use much less opioid medication than they are prescribed. Defining the minimum number of opioids that can be supplied without an increasing rate of refill following surgery may help standardize opioid prescribing guidelines and reduce the excess supply of opioids. Thus, we attempted to determine the correlation between the rate of postoperative opioid prescription refills and the amount of opioid prescribed.
Methods: We studied insurance claims from the Truven MarketScan database to identify opioid-naÃ¯ve patients (no opioid exposure 12 months-6 days before surgery), age 18-64, who underwent shockwave lithotripsy (SWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL) between 2009 and 2015. Our primary outcome was the occurrence of an opioid refill between 6-31 days postoperatively after receipt of a single perioperative prescription within 5 days before to 5 days after surgery. Our primary explanatory variable was the total oral morphine equivalents (OMEs) provided in the initial postoperative prescription. We used logistic regression to examine the probability of an additional refill by initial prescription strength, adjusting for patient factors.
Results: Among 23,749 opioid-naÃ¯ve patients, 79% filled a perioperative opioid prescription. The median initial perioperative prescription was 225 OMEs for all surgery types. 10% of patients refilled their prescriptions. Across procedures, the probability of a postoperative refill did not change with increasing initial OMEs prescribed. Patients undergoing PCNL were more likely to require a refill (OR 1.42, 95% CI 1.02-1.97). History of mental health and pain disorders trended toward association with refill (OR 1.14, 95% CI 1.00-1.30) and (OR 1.10, 95% CI 1.00-1.20) respectively.
Conclusions: The rate of opioid prescription refill after urologic stone surgery was not correlated with initial prescription strength. Given the lack of impact of initial OMEs prescribed on the rate of refill clinicians could begin patients on a lower initial prescription to decrease the potential for leftover pills in the home, diversion of those drugs elsewhere, or chronic opioid use.