Presentation Authors: Walter Cazzaniga*, Milano, Italy, Stacy Loeb, New York, NY, Hans Garmo, Uppsala, Sweden, David Robinson, Jonköping, Sweden, Pär Stattin, Uppsala, Sweden
Introduction: In the United States, there are more than 115 deaths per day from an overdose of opioids. Previous studies from the US have reported that approximately 5% of opioid-naÃ¯ve surgical patients become chronic opioid users after a single prescription postoperatively. The aim of our study was to examine the risk of chronic opioid use following radical prostatectomy (RP) in a different health care system.
Methods: We assessed filled prescriptions for opioids in 25,703 men in Prostate Cancer data Base Sweden (PCBaSe) who had undergone retropubic or robot-assisted RP in 2007-2018. Opioid use was examined in three time periods: preoperative (13 months to 1 month before RP), perioperative (1 month before and 1 month after RP), and postoperative (1 to 12 months after RP). Multivariable logistic regression was used to assess the risk of transition to chronic opioid use, defined as one or more opioid prescription(s) in three consecutive months more than two months after surgery.
Results: The median age at RP was 64 years and 86% of men had a Charlson comorbidity index of 0. A total of 1.9% of men had filled an opioid prescription in the preoperative period, followed by a spike in the perioperative period (59%), which sharply decreased in the second month. In the postoperative period, the percentage of men who had filled an opioid prescription was 2.3% (i.e 0.4% higher than in the preoperative period). Among chronic late users, 43% were new users. Unmarried status, low educational level, retropubic RP, high comorbidity, and more advanced risk category were predictors of transition to chronic use of opioids.
Conclusions: Slightly more than half of Swedish men received opioid prescriptions surrounding radical prostatectomy. The absolute number of patients who became chronic opioid users after surgery was low. Socioeconomic status, comorbidity, cancer characteristics, and surgical approach were all associated with risk of becoming a new chronic user after radical prostatectomy.