Washington, DC (UroToday.com) There is an increasing recognition that postoperative opioid prescriptions are contributing to the opioid crisis in the United States. This is in part due to the diversion of excess opioid medications, but also in part due to the new development of chronic opioid dependence among postoperative patients themselves, which is observed at a rate of 1-6% depending on how it is defined.
In this study, which was presented at the Young Urologic Oncologists Program at the 2019 annual meeting of the Society for Urologic Oncology, Dr. Kathryn Hacker Gessner and her team developed and implemented standardized recommendations for amount of opioid medication to be prescribed after urologic procedures and evaluated the effect of these guidelines on opioid prescriptions, opioid consumption, storage/disposal behavior, pain, and pain interference with daily activities.
The study was conducted in two separate parts. In both parts of the study, patients were contacted two weeks after surgery and assessed on the above parameters. Results of the first part of the study, which ran from 7/2017 to 1/2018 were used to inform the prescription guidelines which were implemented during the second part of the study, which ran from 7/2018 to 1/2019. On average, prior to the intervention 63% of prescribed opioids went unused. The recommendations for opioid prescriptions that were decided on in terms of 5mg oxycodone equivalents were 10 for transurethral resection of bladder tumor, 10 for ureteroscopy, 10 for penile/urethral procedures, 15 for minimally invasive nephrectomy, 20 for minimally invasive prostatectomy, and 15 for cystectomy. 282/678 patients completed surveys in the first period and 156/665 completed surveys in the second time period.
The standard opioid prescribing schedules (SOPS) significantly decreased both the amount of opioid prescribed (average 12 pills) and the amount of opioid used (average ~5 pills). (The decrease in the amount used is consistent with observations made by other groups and may be due to anchoring effect in which the amount of opioid prescribed sets and expectation for the amount that should be taken postoperatively independent of the patients’ actual pain.) There was no difference in pain interference with daily activities as assessed by the PROMIS 6b questionnaire, nor were there differences in patient-reported satisfaction, need for additional medication, or provider phone calls. These results may be somewhat limited by the retrospective nature and the fact that patient education and attitudes towards opioids were note assessed or controlled for.
These results are consistent with others reported in the general surgical literature (Hill et al) and an increasing amount of direct clinical experience as more thoughtful opioid prescription practices are implemented by urologists throughout the US. This data should further strongly encourage those who have not already adopted such practices to do so.
Presented by: Kathryn Hacker Gessner, MD, Ph.D., Department of Urology University of North Carolina School of Medicine
Written by: Marshall Strother, MD, Society for Urologic Oncology Fellow, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA at the 2019 Society for Urologic Oncology Annual Meeting – December 4-6, 2019 – Washington, DC@mcstroth at the 20th Annual Meeting of the Society of Urologic Oncology (SUO), December 4 - 6, 2019, Washington, DC
References: Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ. Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. J Am Coll Surg. 2018;226(6):996-1003.