Presentation Authors: Kian Asanad*, Mary Samplaski, Los Angeles, CA
Introduction: There is robust data demonstrating the relationship between postoperative opioid prescriptions and the risk of chronic opioid dependence. Conversely, there are few guidelines for what prescriptions are appropriate in the postoperative period. Vasectomy is the most common non-diagnostic operation performed by US urologists. The 2010 AUA Guidelines on Vasectomy do not make a recommendation for opioid prescribing post-procedure, which may result in variation in (and possibly over-prescribing of) opioids. We sought to determine urologist patterns of opioid prescribing after vasectomy.
Methods: We designed a 12-question survey that assessed vasectomy experience and post-vasectomy opioid prescriptions. Using the American Medical Association Physician Masterfile database, this was sent to 3000 urologists via e-mail. All responses were anonymous.
Results: 133 responses were received (4.4% response rate). 42.9% of urologists performed 6-10 vasectomies per month, 30.8% performed 0-5 per month and 18% performed 11-15 per month. 86.5% performed vasectomies with the patient fully awake or with oral sedation. 51.5% prescribed opioids for post-procedural analgesia after vasectomy, and 48.5% did not. 77.4% encouraged men to use anti-inflammatories as their primary modality of pain control post-vasectomy. Of urologists who prescribed opioids (oxycodone 5 mg with or without acetaminophen), 67.4% prescribed 5-10 tabs, 31.4% prescribed 11-20 tabs, 1.2% prescribed 21-30 tabs and none prescribed >31 tabs. 50.4% of urologists reported having no idea of what percentage of patients actually used the narcotics that they were written for; 23% said that < 25% of patients used their prescribed narcotics and 16.8% said that 26-50% of patients used their narcotics. Finally, 44.7% of urologists stated that practice guidelines guiding post-vasectomy opioid pain control would be helpful to their practice.
Conclusions: Most urologists perform 6-10 vasectomies per month, generally with the patient awake or with oral sedation. More than three-fourths encourage non-narcotics as the primary means of post-procedure analgesia. While prescribing opioids after vasectomies is common, most urologists do not know how many of their patients actually use these medications. Given the strong relationship between the opioid epidemic and post-procedural opioid prescriptions, practice guidelines on opioid prescribing after vasectomy may help to guide urologists and minimize the number of unnecessary narcotics being prescribed.