Presentation Authors: Crystal Valadon*, Louisville, KY, Tim Large, Julia Fiuk, Charles Nottingham, Amy Krambeck, INDIANAPOLIS, IN
Introduction: In the United States, there is an opioid crises fueled by prescription medications. We recently published data on the feasibility of performing nf-URS. Our concern was that pain after nf-URS would be inadequately managed resulting in poor patient satisfaction and increased workload for ancillary staff. Other than unnecessary opioid exposure, there was no difference in outcomes after nf-URS and standard URS (s-URS) with postoperative narcotics. This is an update on the first 100 cases with nf-URS.
Methods: This is a retrospective review of prospectively maintained data on patients who underwent URS at a tertiary institution treating nephrolithiasis between August 2017 and October 2018. 287 patients underwent URS, of which 95 had nf-URS for stones which were matched to s-URS patients. Patients without an absolute contraindication or allergy to NSAIDs received a prescription for diclofenac instead of a narcotic after nf-URS. Postoperative phone calls to nurses and residents, emergency room visits, and prescription monitoring reports were evaluated for all patients and after nf-URS and s-URS.
Results: Compared to nf-URS, s-URS had higher rates of narcotic use within 12 months leading URS (52 vs 75 p=0.001), however, 7(13%) vs 75(100% p=0.001) of these patients received a narcotic prescription within 90 days post-URS. Overall, an equivalent of 2,500 hydrocodone tablets were avoided in 9 months. Ancillary staff did receive more phone calls (31 vs 19 p=0.04), however, only 8/95 nf-URS patients obtained a narcotic (4 ED, 3 PCP, 1 urology) compared to 24/95 after s-URS. 84% of these patients had a history of prior narcotic use. Of the patients without prior narcotic use, none of the nf-URS patients sought out narcotic pain medication compared to 4 of the 20 undergoing s-URS. The 4 opioid naive patients obtained the opioid prescription, in addition to their postoperative narcotic, from their PCP(1)/ED(3).
Conclusions: Nf-URS is the starting point of opioid stewardship. The US is facing a epidemic crisis fueled by physicians. This research along with the growing evidence supporting narcotic free surgical care needs to be published to empower more physicians to adopt this new standard of care.