National Variation in Opioid Prescription Fills and Long Term Use in Opioid Naive Patients After Urological Surgery

Abstract [from journal]

Purpose: Prescription opioid use is increasing, leading to increased addiction and mortality. Post-operative care is often patients' first exposure to opioids, however little data exists on national prescription patterns in urology. We aimed to examine post-discharge opioid fills after urological procedures and their association with long term use.

Materials and Methods: We identified patients in a private national insurance database undergoing 15 urological procedures between October 1, 2010 and September 30, 2014. Patients with an opioid fill in the preceding 6 months were excluded. Claims for opioids from 30 days before until 7 days after an operation characterized an initial prescription. Factors associated with persistent opioid use (an opioid claim 91-180 days after the operation) and chronic opioid use (≥10 refills for ≥120 days supply in the year following the operation) were analyzed using multivariable logistic regression.

Results: Overall, 96,580 patients were included, and 49,391 (51%) filled an initial opioid prescription. Variation in the initial prescribed amount existed within procedures. Persistent use occurred in 6.2% of patients while chronic use occurred in 0.8%. Increased prescription in patients undergoing transurethral resection of the prostate, vasectomy, female sling, cystoscopy, and stent insertion were associated with an increased risk of both persistent and chronic use.

Conclusions: National variation in opioid prescribing practice exists after urological operations. Patients filling larger amounts of opioids after certain major and minor urological procedures are at an increased risk of long term opioid use. This provides evidence for procedure specific prescribing guidelines to minimize risk and promote standardization.