Podium Session

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PD58-05: Contributing to a crisis? Defining national patterns in opioid prescribing after outpatient vasectomy

Monday, May 15
1:40 PM - 1:50 PM
Location: BCEC: Room 161

Presentation Authors: Gregory Auffenberg*, Rodney Dunn, Yongmei Qin, Tyler Winkelman, James Dupree, Brent Hollenbeck, Ted Skolarus, David Miller, Tudor Borza, Ann Arbor, MI

Introduction: Prescribing surplus opioids after minor surgery can increase risks of misuse in the community. Surgeons may be well positioned to decrease these risks through modification of post-operative prescribing practices. In this context, we define national practice patterns and surgeon-specific differences in opioid prescriptions after outpatient vasectomy.

Methods: Using the de-identified ClinformaticsTM Data Mart Database (OptumInsight, Eden Prairie, MN) from a large, national US health insurer, we identified patients who underwent outpatient vasectomy between 1/2012 and 12/2014. Men were excluded if they received any concurrent operation or filled an opioid prescription in the 6 months prior to vasectomy. For this cohort, we determined the proportion of men filling an opioid prescription in the 7 days after surgery, and evaluated the type and quantity of opioids prescribed, standardized to morphine milligram equivalents (MME). Finally, we quantified surgeon-specific variation in MMEs prescribed for surgeons with 10 or more patients in the cohort, and at least 5 filling an opioid prescription post-operatively.

Results: We identified 25,102 men who received a vasectomy during the study interval. Among this group, 10,442 (41.6%) patients filled an opioid prescription after surgery. Hydrocodone was the most common medication, comprising 66.7% of filled prescriptions. The median number of MMEs prescribed was 112.5 [IQR 82.5-150]; equivalent to twenty-three, 5 mg hydrocodone tablets per prescription [IQR 16.5-30 tablets/ prescription]. Across 360 surgeons meeting criteria for surgeon-specific analysis, the average number of MMEs prescribed after vasectomy varied substantially (range: 29.2-390 MMEs (p<0.001); corresponding to a range of six to seventy-eight, 5 mg hydrocodone tablets per prescription (Figure).

Conclusions: Less than half of men fill an opioid prescription following vasectomy, indicating that non-opioid pain strategies may be sufficient for most patients. Nonetheless, surgeon-specific analyses revealed a 13-fold difference in the average quantity of opioids supplied. Because patient necessity is unlikely to entirely explain this variability, efforts to reduce excess opioid prescribing after vasectomy are warranted.

Source Of Funding: Grant 1T32-CA180984 from the National Cancer Institute

Gregory B. Auffenberg, MD, MS

University of Michigan

Gregory Auffenberg is a Clinical Lecturer and Society of Urologic Oncology (SUO) Fellow in the Department of Urology at the University of Michigan.

After graduating from the Feinberg School of Medicine at Northwestern University, Dr. Auffenberg completed his urology residency training in the Department of Urology at Northwestern. He is currently in the second of three years of fellowship training in urologic oncology. The ongoing research portion of his fellowship has taken place at the University of Michigan within the Dow Division of Urologic Health Services Research and the Division of Urologic Oncology. Dr. Auffenberg obtained a Master's degree in Health and Healthcare Research from the University of Michigan in 2016. In July 2017, Dr. Auffenberg will move to Memorial Sloan Kettering Cancer Center to complete a clinical year of training to round out his SUO training.

Dr. Auffenberg's clinical interests lie across the entire field of urologic oncology. As a reseracher, Dr. Auffenberg is interested in clinical quality improvevment, understanding treatment variation across populations, and exlporing ways to leverage analytics and technology to provide physicians and patients with further insights into patterns of care.

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