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EAU 2019

EAU 2019: New Persistent Opioid Use After Ureteroscopy for Stone Treatment

Barcelona, Spain (UroToday.com) Postoperative pain is often managed by opioids. However, such an approach can often lead to long-term opioid use and cause adverse effects including respiratory depression. As a consequence, over 100 Americans die every day from opioid overdose. In the study from The University of Michigan, the authors measured the incidence of persistent opioid use following ureteroscopy (URS) for stone treatment.

Adult patients from Clinformatics DataMart™ Database who underwent outpatient URS for stone treatment between January 1, 2008, and December 31, 2016, were included in the study. A primary outcome was new persistent opioid use and it was defined as previously opioid-naïve patients (i.e., those with no opioid prescriptions between 12 months and 31 days before surgery), who filled an opioid prescription attributed to surgery and then filled at least one additional opioid prescription between 90 and 180 days after surgery. A multivariable logistic regression model was used to determine patient factors associated with new persistent opioid use. Patients underwent a repeat intervention were excluded from the study.

Of 48,576 patients who underwent outpatient URS for stone treatment, 53% were opioid-naïve, 33% were intermittent opioid users, and 14% were chronic opioid users. Among opioid-naïve patients (n = 24,053), 1,671 (7%) developed new persistent opioid use after URS. Three months after surgery, patients with new persistent opioid use continued to fill opioid prescriptions. Patient-related risk factors included filling an opioid prescription within the 30 days before surgery (odds ratio (OR), 1.26; 95% confidence interval (CI), 1.12 to 1.41) and female gender (OR, 1.17; 95% CI, 1.06 to 1.30). In addition, a high amount of opiates during the surgery increased the risk of becoming new persistent opioid users.

Nearly 1 in 14 opioid-naïve patients go on to persistent opioid use after URS for stone treatment. Considering these data, urologists should consider alternatives to opioids for postoperative pain management, especially in patients taking large amounts of opiates during the surgery. It should be noted that the study design did not allow to evaluate stone-related factors and the use of other painkillers.

Presented by: John Hollingsworth, MD, University of Michigan Medical School, Department of Urology, Ann Arbor, Michigan

Written by: Kirill Shiranov, MD, Fellow, Department of Urology, Rostov University, Rostov on Don, Russia at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain from March 15-19, 2019.