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EAU 2019

EAU 2019: Practice-Level Variation in Postoperative Pain Management After Ureteroscopy: Lessons from a Statewide Collaborative Quality Initiative

Barcelona, Spain (UroToday.com) Postoperative pain is one of the most common reasons for emergency department visits after ureteroscopy (URS). Thus, efforts focused on optimizing postoperative pain management likely will have salutary effects on patient’s postoperative care. However, before such efforts can be launched, baseline information on contemporary pain medication prescription patterns is needed.

For this study, Dr. Hollingsworth and colleagues used the Michigan Urological Surgery Improvement Collaborative’s Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) initiative. MUSIC ROCKS maintain an all-payer clinical registry in which detailed patient and perioperative information are prospectively captured for patients undergoing URS at a participating practice in Michigan. Authors abstracted registry data on and calculated practice-level use of postoperative opiates, non-steroidal anti-inflammatory drugs (NSAIDs), and alpha blockers. Authors supplemented these data with a 15-item survey that was administered to MUSIC ROCKS’ urologists regarding their postoperative pain management strategies.

The response rate of the survey was 67%. Data was obtained on 5,600 URS procedures performed across 34 participating practices between June, 2016 and September 2018. 86% of these patients received an opiate prescription as part of their postoperative pain management, 85.1% were managed with an opiate alone. For only 11.5% of patients was an NSAID included in the postoperative pain regimen. In contrast, 46.6% of survey respondents indicated that they prescribed an NSAID after a majority of their cases.  Registry data revealed that 55.1% and of patients were prescribed alpha-blockers postoperatively. This rate varied substantially between practices, and only 18.7% of survey respondents prescribed anticholinergics in a majority of their patients.

Based on their results, the authors concluded that there is substantial variability in urologists’ approach to pain management after URS across Michigan.  The study highlights the low use of NSAIDs, alpha blockers, and anticholinergics, suggesting opportunities for improvement.

Presented by: John M. Hollingsworth, MD the University of Michigan, Department of Urology, Ann Arbor, Michigan, United States

Written by: Ali Stanislav Ph.D., MD, Fellow, Department of Urology, Sechenov University, Moscow, Russia and Zhamshid Okhunov, MD, Twitter: @OkhunovZham, Department of Urology, the University of California-Irvine at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.