Presentation Authors: Kristian Stensland*, Burlington, MA, Joan Delto, Omaha, NE, Peter Chang, Sarah Hyde, Boston, MA, Aaron Berkenwald, Burlington, MA, Kyle McAnally, Catrina Crociani, Brian Holliday, Analesa Baraka, Jodi Mechaber, Boston, MA, Marc Manganiello, David Canes, Alireza Moinzadeh, Burlington, MA, Andrew Wagner, Boston, MA
Introduction: Overprescription of narcotics after surgery contributes significantly to the ongoing opioid crisis. Therefore, interventions to minimize the quantity of pills prescribed postoperatively are timely and critical. We assessed perioperative and post-discharge narcotic utilization to identify factors associated with low or no home opiate use.
Methods: Patients prospectively recorded their home pain pill usage on a pain pill log, including narcotics, acetaminophen, and ibuprofen, following robotic radical prostatectomy (RP) and robotic partial nephrectomy (PN) at 2 academic institutions. At the first postop visit, clinic staff counted remaining narcotic pills to verify reported narcotic utilization. We extracted data on in-hospital pain medication use (measured in morphine equivalents), pain score on POD1, and patient comorbidities from electronic medical records. We applied multivariate logistic and linear regression to identify factors associated with no postoperative pill use and degree of pill use.
Results: A total of 117 RP and 47 PN patients had complete data and were included in the study. Patients were prescribed 5-30 oxycodone pills at time of discharge. For RP patients, 52% of patients took 0 pills after discharge, and 91% took 10 or fewer pills. If 5 pills were prescribed, 82% of patients would not require a narcotic refill post-operatively. Patients using fewer perioperative narcotics and with lower pain scores on day of discharge used fewer pills after discharge. On multivariate analysis controlling for age, chronic pain, and baseline alcohol and drug use, each additional perioperative morphine equivalent use was associated with an OR of 0.94 [95% CI 0.89-0.98, p = 0.004], and each additional point on postop pain scale had an OR of 0.73 [95% CI 0.54-0.95, p = 0.026] for requiring no narcotics post-discharge. For PN patients, 43% of patients took 0 pills after discharge, and 77% took 10 or fewer pills. If 10 pills were prescribed, 76% of patients would not require a narcotic refill post-operatively. Similar to RP, on multivariate analysis PN patients with higher postop pain score (OR 0.52 [95% CI 0.26-0.89], p = 0.036) and greater periop pain requirements (OR 0.95 [95% CI 0.90-0.99], p = 0.053) had lower odds of remaining narcotic free post-discharge.
Conclusions: Most patients take few, or zero, prescribed narcotics after robotic urologic surgery. Patients with low postop pain scores, and who take few narcotics while in-hospital, may not need narcotic prescriptions for discharge. Clinicians should utilize these parameters to aid in limiting numbers of prescribed but unused pills.