SESAUA 2023: Perioperative and New Persistent Opioid Use in Cystectomy Patients

( The 2023 SESAUA annual meeting included a bladder cancer session, featuring a presentation by Dr. Hailey Holck discussing perioperative and new persistent opioid use in cystectomy patients. In large database studies, major surgery has been associated with new persistent opioid use in up to 10% of patients.

Furthermore, cancer patients are also at an increased risk for continued postoperative opioid use. However, there is limited data describing new persistent opioid use in radical cystectomy patients. At the SESAUA 2023 annual meeting, Dr. Holck and colleagues described the use of a novel clinical opioid misuse and diversion identification tool to assess pre and postoperative opioid use patterns in an updated cohort of radical cystectomy patients.

This study included a retrospective query of a prospectively maintained, IRB-approved radical cystectomy database at Levine Cancer Institute/Atrium Health using patients from January 1, 2017 to January 1, 2021. Dr. Holck employed Prescription Reporting with Immediate Medication Utilization Mapping (PRIMUM)—a clinical decision support intervention tool that identifies risk factors for misuse, abuse, and diversion of controlled substances. Opioid prescriptions were assessed for nine months prior to surgery, and new persistent use was defined as an opioid prescription between 91 and 365 days postoperatively in patients without preoperative prescriptions. McNemar tests for agreement compared the opioid usage pre versus post cystectomy.

 This cohort included 258 patients, consisting of 76.4% male with an average age of 71 years. Surgery was performed by open approach in 34.1% of cases and robotically in 65.9% of patients. In the nine months preceding surgery, 137 (53.1%) patients had zero narcotic prescriptions, 66 (25.6%) had one, and 55 (21.3%) had two or more prescriptions. Postoperatively, 20 patients (14.6%) demonstrated new persistent opioid use. There was a significant difference between the postoperative narcotic prescriptions and pre-operative opioid use (p<0.001):

postop opiod perscriptions.jpg

Dr. Holck concluded her presentation discussing perioperative and new persistent opioid use in cystectomy patients with the following take-home messages:

  • Postoperative opioid use varies significantly with preoperative opioid use in patients undergoing radical cystectomies
  • Radical cystectomy is also associated with a new persistent opioid use rate of 14% in this cohort
  • Additionally, 23.6% of patients undergoing cystectomy demonstrated persistent opioid use
  • This underscores the continued importance of investigating opioid use in ERAS cystectomy patients to mitigate the risk of unnecessary opioid use
  • Future studies will explore patterns of opioid use in cystectomy patients and whether ERAS can mitigate or moderate persistent use

Presented by: Hailey Holck, Levine Cancer Institute/Atrium Health, Charlotte, NC

Co-Authors: Samuel Ivan1, Rachel Locke1, Myra Robinson, MSPH2, Peter Clark1, Kris Gaston1, Stephen Riggs1

Affiliations: 1Department of Urology, Levine Cancer Institute/Atrium Health, 2Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health

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 2023 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting, Amelia Island, FL, Wed, Mar 15 – Sat, Mar 18, 2023.