Presentation Authors: Elizabeth Green*, Petria Thompson, Kristen Scarpato, Kirk Keegan, Sam Chang, David Penson, Daniel Barocas, Matthew Resnick, Nashville, TN
Introduction: Narcotic use is a growing public health concern and poses significant challenges in the perioperative period. The aim of this study was to characterize the relationship between pre-operative narcotic use and post-operative outcomes in patients undergoing radical cystectomy.
Methods: We performed a retrospective cohort study comprising all patients residing in Tennessee or contiguous states who underwent radical cystectomy at a single institution from January 2013 to August 2015. Controlled substances data were obtained from the Tennessee Controlled Substances Medication Database from 1 year prior to surgery through 1 year after surgery and linked to clinical and demographic data abstracted from the medical record. We identified clinical, demographic, and prescription data that were associated with post-operative outcomes using bivariate non-parametric statistical testing and multivariate generalized linear model, Poisson regression and logistic regression when appropriate.
Results: 267 patients underwent radical cystectomy, 134 of whom were prescribed narcotics in the year prior to cystectomy. There was a statistically significant association between the number of in-hospital complications and the pre-operative morphine equivalent dose (MED) on bivariate (RR 1.021, P=0.024) but not on multivariate analysis (RR 1.01, 95%CI 1.00-1.03, P=0.0795). Additionally, there was also a statistically significant association between the total number of complications within 90 days of discharge and the pre-operative MED for 1 year prior to surgery on bivariate (RR 1.021, 95% CI 1.002-1.04, P=0.027) and on multivariate regression (RR 1.02, 95% CI 1.00-1.04, P=0.029). Among patients that filled a narcotic prescription prior to cystectomy, MED in the year prior to surgery was an independent predictor of length of stay (OR 1.08, 95%CI 1.01-1.16, P=0.019). There was no association between MED for the year prior to surgery and Emergency Department visits (p=0.41) or readmissions (p=0.88).
Conclusions: For patients undergoing radical cystectomy at a quaternary care referral center, morphine equivalent dose was an independent predictor of complications and was an independent predictor of length of stay in those patients who had filled a narcotic prescription in the year before surgery. Our findings suggest that greater vigilance of narcotic use prior to cystectomy is warranted and that narcotic stewardship in patients being considered for cystectomy could have benefits in the perioperative period.