Presentation Authors: Brittney Cotta*, Seth Bechis, San Diego, CA
Introduction: Opiate abuse is a national health crisis. In a urology practice, patients presenting with acute nephrolithiasis may be at risk. We sought to analyze prescribing patterns in our institution and identify risk factors associated with continued use of opiates during episodes of acute renal colic.
Methods: Retrospective study of patients who presented to our endourology clinic from 6/1/2017-6/1/2018 with both a stone confirmed on imaging and an acute pain episode. Opiate prescription data was obtained from the California Controlled Substance Utilization Review and Evaluation System. Primary outcome was an opiate refill prior to resolution of the stone episode (either passage or surgery). Univariate and multivariable linear regression analysis was performed.
Results: A total of 94 patients met inclusion criteria. Mean age was 52 years (63% male), and 52% had a history of nephrolithiasis. Seventy-seven (82%) patients initially presented to the Emergency Department (ED), and 63 (67%) patients filled an opiate prescription during their acute stone episode. Sixteen (17%) patients had an existing opiate prescription filled up to 3 months before their stone episode and were over twice as likely to require a refill (p=0.07). A total of 28 (30%) patients refilled an opiate prescription prior to resolution of their stone episode (Table 1). Univariate analysis demonstrated longer time to stone resolution (52 vs 33 days, p=0.049), larger stone size (9 vs 5 mm, p=0.015), opiate prescribed at presentation (86 vs 53%, p=0.003), and surgery needed to clear the stone (86 vs 44%, p < 0.001) were associated with increased risk of requiring an opiate prescription refill. On multivariable analysis controlling for age, sex, stone size, and time to stone passage or surgery, an opiate prescription at presentation (95% CI 0.090-0.433, p=0.003) and surgery to clear the stone (0.044-0.440, p=0.017) were independent predictors of opiate refills prior to stone resolution.
Conclusions: Patients prescribed opiates in the ED for acute nephrolithiasis are likely to require refills before resolution of the stone episode. Larger stones that require surgery (not spontaneous passage) also increase the risk. Timely treatment of these patients and initial treatment with non-narcotics may reduce the risk of prolonged opiate use.