ACS 2019: The Opioid Epidemic and Urology: The Effects of Pre-Operative Opioid Usage on Post-Operative Clinical Outcomes in Radical Cystectomy Patients

San Francisco, California ( Blair Townsend, MD, MBA, Carolinas Medical Center, Charlotte, NC, Levine Cancer Institute, Atrium Health, Charlotte, NC, presented a retrospective cohort study describing opioid use prior to and after radical cystectomy (RC). On October 26, 2017, the White House declared the opioid crisis a national “Public Health Emergency.” Recognizing the extensive societal impact of this epidemic, they sought to examine pre-operative opioid usage in our RC patients. They aimed to study the effects of this usage on several clinical outcomes.

From 1/1/2015-9/30/2018, 179 patients underwent RC at a single institution. 32 of these patients were on a single active opioid medication (“single usage” cohort), 7 patients were on >1 active opioid medications (“multiple usage” cohort) and 140 had none (“no usage” cohort) at the pre-operative clinic visit. Length of stay (LOS), time to pain control, 30-day readmission rates, and cost of a primary stay, were compared between the three cohorts using Fisher’s exact and median two-sample tests.

They found trends in median time (nights) to pain control in the “no usage”, “single usage,” and “multiple usage” cohorts, respectively, favored less pre-operative opioid usage (3, 3.5, 5, p=.343). Median LOS (days) was highest in the “multiple usage” cohort (8) and similar for “no usage” and “single usage” cohorts (6, 6, p=.114). Trends in 30-day readmission rates for “no usage,” “single usage,” and “multiple usage” cohorts, respectively, favored less pre-operative opioid usage (17.4%, 21.9%, 28.6%, p=.546).

Overall, these findings might suggest more favorable outcomes in those patients not requiring an active narcotic prescription before surgery. Future work will focus on further characterization of pre-operative opioid use and the effects on outcomes in a larger cohort of patients. The study was limited by no standardization of early recovery after surgery (ERAS) protocol described and limited numbers of patients but the authors should be commended for their opioid stewardship at their institution.

Presented by: Blair Townsend, MD, MBA, Carolinas Medical Center, Charlotte, North Carolina, Levine Cancer Institute, Atrium Health, North Carolina

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California