Presentation Authors: Mohammed Said*, Atlanta, GA, Andrew Leung, Dattaraya Patil, Kenneth Ogan, Akanksha Mehta, Christopher Filson, Aaron Lay, Atlanta , GA
Introduction: The USA is in the midst of an opioid epidemic, the scope of which is currently being elucidated. Given the widespread use of postoperative opioids, identifying patients at risk for prolonged opioid use is an important avenue for prevention. Thus, we evaluated the risk and incidence of prolonged opioid use in opioid-naÃ¯ve patients after kidney stone surgeries.
Methods: We studied insurance claims from the Truven MarketScan to identify opioid-naive patients, age 18-64, who underwent shockwave lithotripsy (SWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL) between 2009 and 2015. Patients were observed for 6 months to determine the number and oral morphine equivalent (OME) dosage of postoperative opioid prescriptions. We assessed prolonged opioid use, defined as patients who filled a perioperative opioid prescription followed by a prescription between 90 and 180 days after surgery, and evaluated risk factors using logistic regression.
Results: 50,249 opioid-naive patients filled a perioperative. Of these, 8.1% of patients continued to fill prescriptions between 90 and 180 days after surgery. In multivariate models there was no significant difference between URS, SWL, or PCNL in prolonged opioid use. There was an association between greater total OME prescribed peri-operatively and prolonged opioid use; patients receiving the 80th percentile of OMEs were more likely than patients receiving < 20th percentile, OR 1.28 (1.15-1.41, p < 0.01). Pain and mental health disorders were associated with prolonged opioid use, OR 1.31 (1.22-1.41, p < 0.01) and OR 1.24 (1.13-1.36, p < 0.01), respectively. Substance and alcohol abuse as well as tobacco use also associated, OR 1.80 (1.38-2.35) and OR 1.26 (1.06-1.49). Other variables that were associated with prolonged opioid use include female gender, multiple procedures, higher Charlson comorbidity index, and region.
Conclusions: 8.1% of opioid-naive patients continue to fill opioid prescriptions 90 days after stone surgery. Surgery was not associated with prolonged use. Receiving relatively large doses of opioids relative to the lowest quintile was associated with prolonged use. Preoperative interventions centered on opioid alternatives and early cessation, particularly among patients at risk for long-term use, such as those with pain and mental health disorders as well alcohol, substance and tobacco use, are critical to addressing the prescription opioid crisis in the USA.