Category: Epidemiology, Health Policy, Socioeconomics & Outcomes

MP28-1 - Analgesic Prescribing Patterns in Emergency Departments for Acute Symptomatic Urolithiasis in the United States, 2006-2014

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

A critical barrier to addressing the ongoing opioid crisis in the US is understanding current prescribing patterns for acute pain, such as pain associated with symptomatic urolithiasis. For symptomatic urolithiasis, non-opioids, such as nonsteroidal anti-inflammatory drugs, are equally efficacious, longer lasting, and safer than opioids. Given this context, our objective is to describe analgesic prescribing patterns and trends for symptomatic urolithiasis in US emergency departments (EDs) from 2006 to 2014.


Methods :

We conducted a cross-sectional analysis of visits for urolithiasis in the 2006–2014 National Hospital Ambulatory Medical Care Survey-Emergency Department. Established diagnostic codes were used to identify all adult (≥18 years) visits for urolithiasis. The primary outcome was pain medication type administered, which was identified using Multum Lexicon third-level drug categories. Covariates included medication administration setting, pain on admission, age, gender, and race. Pain severity was derived from the standard 10-point pain scale (mild [1-3], moderate [4-6], or severe [7-10] pain). Nationally representative estimates were analyzed using the Rao-Scott chi-square test or Z-test, as appropriate. 


Results :

From 2006 to 2014, there were approximately 13 million US ED visits for urolithiasis. Overall, opioid prescribing for symptomatic urolithiasis increased from 70% in 2006 to 84% in 2014 (P=0.011 for trend). Opioids were prescribed during visits at a rate of 61% and at visit discharge at a rate of 53%. Non-opioids were prescribed during visits at a rate of 52% and at visit discharge at a rate of 18%. The majority (73%) of patients with severe pain received opioids during their visit. Almost half (44%) of patients reporting mild pain received an opioid during their visit. At visit discharge, 52% of patients with mild pain were prescribed opioids and 59% of patients with severe pain were prescribed an opioid, with no statistical difference between the proportions (P=0.423). Non-white patients were less likely to receive opioids than white patients during their ED visit (54% vs. 61%, P=0.044) and at visit discharge (43% vs. 56%, P=0.019).


Conclusions :

Despite the evidence that non-opioids are safer, more effective, and longer lasting than opioids, US physicians continue to liberally prescribe opioid analgesics for symptomatic urolithiasis. Our findings highlight the need for strategies to minimize opioid use for symptomatic urolithiasis and understand differences in pain management.

Brenton B. Winship

Endourology Fellow
Duke University Medical Center, Division of Urology
Durham, North Carolina

Leonid I. Aksenov

Medical Student - Year 4
Duke University School of Medicine
Durham, North Carolina

Ashley W. Johnston

Duke University Medical Center, Division of Urology
Durham, North Carolina

Russell S. Terry

Endourology Fellow
Duke University Medical Center, Division of Urology
Durham, North Carolina

Fellow in Endourology, Metabolic Stone Disease, Laparoscopy, and Robotic Surgery
Division of Urologic Surgery
Duke University Medical Center

Michael E. Lipkin

Associate Professor Urology
Duke University Medical Center, Division of Urology
Durham, North Carolina

Jonathan C. Routh

M.D.
Duke University Medical Center, Division of Urology
Durham, North Carolina

Glenn M. Preminger

Duke University Medical Center, Division of Urology
Durham, North Carolina

Charles D. Scales

Associate Professor
Duke University Medical Center, Division of Urology
Durham, North Carolina

Charles D. Scales, Jr., MD MSHS is Associate Professor of Surgery (Urology) and Population Health at Duke University School of Medicine and Vice Chief for Quality Improvement and Patient Safety in the Division of Urologic Surgery. He completed medical school and residency training in urology at Duke University Medical Center. After residency, Dr. Scales completed the Robert Wood Johnson Foundation Clinical Scholars Program at UCLA, where he received advanced training in health services research, health policy, and quality of care.

Dr. Scales has a strong interest in education, having previously served on the ACGME Review Committee for Urology and as a member of the ACGME Board of Directors. He currently leads a course in quality improvement and data analytics in the Masters of Management in Clinical Informatics program at the Duke University School of Medicine.

From the research perspective, Dr. Scales has a longstanding interest in the epidemiology of and patient care for urinary stone disease. Recent studies have redefined the burden of urinary stone disease in the United States, compared the effectiveness of dominant stone removal technologies, and identified new opportunities for improving patient-centered and policy-relevant outcomes, such as unplanned care after procedural interventions. His research and perspective on urinary stone disease has been highlighted in U.S. News & World Report, Reuters, NPR, and the Wall Street Journal, among other media outlets.

As a result of these investigations, he has an appointment at the Duke Clinical Research Institute where he leads a diverse health services and clinical research program. He has received research support from the National Institute of Aging, the American Geriatrics Society, and philanthropic funding, among other sources. Currently, Dr. Scales is the Principal Investigator for the Scientific Data and Research Center for the NIDDK Urinary Stone Disease Research Network (U01).