Presentation Authors: Paige Nichols*, Matthew Gettman, Jason Joseph, Daniel Ubl, Rochester, MN, Mark Tyson, Raymond Pak, Scottsdale, AZ, Halena Gazelka, Bradley Leibovich, Elizabeth Habermann, Matthew Ziegelmann, Rochester, MN
Introduction: Previous work has identified disconnect between opioid prescribing and utilization. This is particularly relevant for minimally-invasive surgery. However, factors that contribute to differences between patient utilization and surgeon prescribing are less clear. Here, we evaluate post-discharge opioid use after minimally invasive urologic surgery and identify characteristics associated with patient utilization patterns.
Methods: Patients undergoing minimally invasive prostatectomy (MIP) and minimally invasive nephrectomy (MIN) at three affiliated academic institutions from March 2017 to January 2018 were prospectively identified as part of a larger multi-specialty initiative. Data regarding postoperative prescribing was evaluated. Patients were contacted at 21 to 35 days postoperatively and asked to complete a 29-question survey that included opioid utilization, refills, and pain control perceptions. Opioids were converted to oral morphine equivalents (OME) for comparison. Univariable analysis evaluated the influence of patient demographics, postoperative pain scores, and opioid prescribing on consumption and refill rates.
Results: Nearly all respondents received an opioid after MIN (97/100) and MIP (98/101). For both MIN and MIP, pre-operative opioid use (5.0% vs 12.0%, p=0.07) and discharge OME (both 225 OME; p=0.78) were similar. Median OME consumed was 37.5 and did not significantly differ between MIN and MIP (42.5 vs 30.0; p=.44). Among patients receiving opioids at discharge, median percentage of unused opioids was 83.3% (IQR 37.5% - 100%) and approximately 32% of respondents did not consume any OME (p=0.96). Patients in the highest quartile of OME consumption (Q4) consumed a median 210 OME compared with a median 22.5 OME for Q1-3. Q4 patients had higher median pain scores at discharge compared with Q1-3 (4 vs 2; p < .01) and were more likely to have a prolonged length of stay, defined as Q4 hospitalization duration (26.5% vs 12.8%; p=.02). Those in Q4 were less likely to report satisfaction with their pain control after discharge (83.7% vs 98.0%; p < .01) and had higher opioid refill rates (22.4% vs 6.0%; p < .01) even though these patients were prescribed more OME on average (299.0 vs 218.1; p < .01).
Conclusions: Opioid overprescribing is common after minimally-invasive urologic surgery as the vast majority of opioids go unused. Future iterations of clinical prescribing guidelines should consider utilizing patient specific factors such as discharge pain scores to further optimize postoperative opioid prescribing.