SES AUA 2022: Prolonged Opioid Use Following TURBT: Insurance Claims Review of High-Risk Prescribing to Opioid-Naive Patients

( The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Benjamin Croll discussing prolonged opioid use following transurethral resection of bladder tumor (TURBT) specifically for opioid-naïve patients. Urologic and general surgical data have shown in numerous settings that opioid-naïve patients prescribed postoperative opioids are at increased risk of developing opioid dependence and persistent use. Bladder cancer patients represent a high-risk group for opioid dependence due to the frequency of surgical procedures. The objective of this study was to use MarketScan insurance commercial claims and Medicare-eligible supplemental databases to identify whether receiving initial post-TURBT opioids resulted in an increased likelihood of prolonged use. Dr. Croll and colleagues additionally sought to identify opioid prescribing trends over time and in different treatment groups.

This study analyzed 31,395 commercial claims and 33,333 Medicare-eligible patients with a new diagnosis of bladder cancer and no opioid prescriptions for 6 months prior to initial TURBT from 2009 to 2019. Dr. Croll assessed those who received initial post-TURBT opioids (commercial claims: n=7,574 (24.1%); Medicare-eligible: n=5,577 (16.7%)) and the initial dose of opioids in oral morphine equivalents. A subgroup analysis was performed by gender and in those who eventually underwent radical therapy.

Multivariate regression analysis revealed that those who received initial post-TURBT opioids were more likely to fill additional prescriptions between 3-6 months (commercial claims: OR 1.20, 95% CI 1.12-1.29; Medicare-eligible: OR 1.29, 95% CI 1.20-1.40). Ordinal data analysis revealed median oral morphine equivalents values of 150.0, which is the equivalent of 20 oxycodone 5-mg pills. Increasing quartile oral morphine equivalents of initial post-TURBT opioids predicted increased odds of prolonged opioid use.

The odds of an opioid refill within one month of TURBT were higher for those who underwent future radical or non-radical therapy compared to those with no further treatment. Furthermore, Medicare-eligible women (compared to men) received higher median oral morphine equivalents prescriptions at 2-3 months (210.0 vs. 187.5) and 3-6 months (270.0 vs. 216.3), both p < 0.001. Finally, Medicare-eligible men were less likely to have prolonged use at 3-6 months (OR 0.92 95% CI (0.86-0.98).

Dr. Croll concluded his presentation assessing prolonged opioid use following TURBT specifically for opioid-naïve patients with the following concluding statements:

  • These results suggest that prescribing initial post-TURBT opioids increases the likelihood of continued use at 3-6 months
  • Those who go on to radical treatment are refilling opioids at a higher rate at one month post-TURBT
  • Medicare-eligible men were receiving lessor quantities of opioids in the months following TURBT and were less likely to have prolonged use
  • These data suggest that short-term prescriptions have long-term effects, and additional research on surgical outcomes, oncologic outcomes, and opioid dependence is warranted 
Presented by: Benjamin Croll, Emory University, Department of Urology, Atlanta, GA

Co-Authors: Dattatraya Patil, Misaki Mason, Vikram Narayan, Viraj Master, Christopher Filson, Shreyas Joshi

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 86th Annual Meeting of the Southeastern Section of the American Urological Association, San Juan, PR, Mar 16 – 19, 2022