Category: Clinical Stones: Outcomes

MP8-12 - Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Stone Surgery

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : The United States is in the midst of an expanding opioid epidemic, the scope of which is currently being elucidated. The extent of the problem is unique to the United States, with Americans consuming 80% of the global opioid supply while representing only 5% of the world’s population.  Given the widespread use of postoperative opioid analgesics, identifying patients at risk for prolonged opioid use is an important avenue for prevention. Thus, we evaluated the risk of prolonged opioid use in opioid-naïve patients after common urologic kidney stone surgeries in the United States. 


Methods :

We studied insurance claims from the Truven MarketScan database to identify opioid-naïve patients (no opioid exposure 11 months before the perioperative period), age 18-64, who underwent (shockwave lithotripsy (SWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL)) between 2010 and 2015 (n=81,662). Patients were observed for 6 months to determine the number, timing and oral morphine equivalent (OME) dosage of postoperative opioid prescriptions. We assessed prolonged postoperative opioid use, defined as patients who filled a perioperative opioid prescription followed by a prescription between 90 and 180 days after surgery, and evaluated associated risk factors using multivariable logistic regression. 


Results : Among 68,210 opioid-naïve patients, 83.7% filled a perioperative opioid prescription between 31 days preceding surgery to 14 days after. Of these, 10.2% of patients continued to fill prescriptions between 90 and 180 days after surgery. In multivariate models patients undergoing PCNL were more likely to continue to fill opioid prescriptions after 90 days compared with URS or ESWL (OR:1.29 (1.05-1.58), p = 0.01). Patients who received > 75th percentile total OME in the perioperative period were also at greater risk of prolonged opioid use (OR: 1.15 (1.07-1.23), p= 0.01). Mental health disorders, female gender, repeat surgery, higher Charlson comorbidity index, and region were also associated with prolonged opioid use. 


Conclusions : In this study, 10.2% of opioid-naïve patients continue to fill opioid prescriptions 90 days after stone surgery. Prolonged opioid use is more common after PCNL compared to other stone surgeries. Importantly, higher total OME received in the perioperative period is associated with prolonged use. Preoperative interventions centered on opioid alternatives and early cessation, particularly among patients at risk for long-term use, is critical to addressing the prescription opioid crisis in the United States.

Mohammed Said

Resident
Department of Urology, Emory University School of Medicine
Atlanta, Georgia

Andrew Leung

Resident
Department of Urology, Emory University School of Medicine
Atlanta, Georgia

Dattatraya Patil

Biostatistician
Department of Urology, Emory University School of Medicine
Atlanta, Georgia

Kenneth Ogan

Professor
Department of Urology, Emory University School of Medicine
Atlanta, Georgia

Akanksha Mehta

Asst Professor
Department of Urology, Emory University School of Medicine
Atlanta, Georgia

Christopher Filson

Asst Professor
Department of Urology, Emory University School of Medicine
Atlanta, Georgia

Aaron Lay

Asst Professor
Department of Urology, Emory University School of Medicine
Atlanta, Georgia

Dr. Lay received his medical degree from Washington University School of Medicine in St. Louis in 2009. He completed his general surgery internship and urology residency at Brigham and Women's Hospital, after which he did an endourology and minimally invasive surgery fellowship at the University of Texas Southwestern Medical Center from 2014-2016. Dr. Lay directs the Endourology and Kidney Stone Program at Grady Memorial Hospital.