Presentation Authors: Marieke Johanna Krimphove*, Alexander Putnam Cole, Karl Heinrich Tully, Xi Chen, Stuart R. Lipsitz, Paul L. Nguyen, Toni K. Choueiri, Adam S. Kibel, Boston, MA, Luis A. Kluth, Frankfurt, Germany, Quoc-Dien Trinh, Boston, MA
Introduction: Increasing deaths attributed to opioid drugs have become a major public health problem in the United States. Undergoing major surgery may trigger opioid addiction. We sought to investigate differences in the number of days of prescribed opioids after differing surgical approach (open vs. robotic) for major urologic procedures.
Methods: We used the IBM Watson Health MarketscanÂ® Commerical Claims and Encounters Database to identify opioid-naÃ¯ve individuals aged 18-64 who underwent either radical prostatectomy, radical or partial nephrectomy or cystectomy between 2012 - 2017. Propensity weighted multivariable regression analyses were used to determine the independent effect of surgical approach on the "days of opioids supplied" defined as opiod prescriptions within 90 days of surgery. Seven orally administered opioid analgesic agents were included in the analysis. We controlled for risk factors for chronic opioid abuse including history of depression, alcohol abuse, drug abuse, use of benzodiazepines, antidepressants, and antipsychotics within the year prior to surgery.
Results: We identified 16,776 men who underwent radical prostatectomy (19.2% open, 80.8% robotic), 2,356 individuals who underwent radical nephrectomy (69.5% open, 30.5% robotic), 3,748 who underwent partial nephrectomy (37.3 % open, 62.7% robotic), and 642 who underwent cystectomy (80.5% open, 19.5% robotic). The adjusted mean differences in days opioids were supplied between open vs. robotic surgery were 0.66 days (95% confidence interval (95% CI 0.49 - 0.84, p < 0.001) for radical prostatectomy, 2.15 days (95% CI 1.15 -3.15, p < 0.001) for radical nephrectomy, 2.65 (95% CI 2.04 - 3.25, p < 0.001) for partial nephrectomy and 1.59 (95% CI -0.03 - 3.22, p=0.055) for cystectomy. The differences were statistically significant except for cystectomy.
Conclusions: The days of opioids supplied were fewer after robotic surgery compared to open surgery. However the differences in days supplied were small and clinical relevance is uncertain. Further investigations are needed to better understand the effect of surgical approach on opioid prescriptions and abuse in a long term perspective.
Source of Funding: Brigham Research Institute, Bruce A. Beal and Robert L. Beal Surgical Fellowship, Conquer Cancer Foundation, Defense Health Agency, Intuitive Surgical, Prostate Cancer Foundation, Vattikuti Urology Institute.