New persistent opioid use after ureteroscopy for stone treatment
Tam C, Yan P, Raisky J, Gunaseelan V, Kim T, Leavitt D, Dauw C, and Hollingsworth JM. New persistent opioid use after ureteroscopy for stone treatment. European Urology, Supplements 2019; 18(1):e196-e197.
European Urology, Supplements
Introduction & Objectives: Over 100 Americans die every day from opioid overdose. Emerging data suggest that many opioid addictions surface after surgery. To examine this issue, we measured the incidence of persistent opioid use following ureteroscopy (URS) for stone treatment. Materials & Methods: Utilizing the Clinformatics DataMart™ Database, we identified adults who underwent outpatient URS for stone treatment between January 1, 2008 and December 31, 2016 and filled an opioid prescription attributed to surgery. Our primary outcome was new persistent opioid use—defined as previously opioid-naïve patients (i.e., those with no opioid prescriptions between 12 months and 31 days before surgery), who filled an opioid prescription attributed to surgery and then filled at least one additional opioid prescription between 90 and 180 days after surgery. We then fit a multivariable logistic regression model to determine patient factors associated with new persistent opioid use. Results: Over the study period, 48,576 patients underwent outpatient URS for stone treatment. Of these, 53% were opioid-naïve, 33% were intermittent opioid users, and 14% were chronic opioid users. Among opioid-naïve patients, 1,671 (7%) developed new persistent opioid use after URS. The figure shows the trajectory of mean daily opioid dose with patients stratified by perioperative opioid use. Three months after surgery, patients with new persistent opioid use continued to fill opioid prescriptions, corresponding to less than 1 tablet per day of 5-mg hydrocodone (3.3 oral morphine equivalents). Patient factors associated with increased odds of new persistent opioid use included filling an opioid prescription within the 30 days before surgery [odds ratio (OR), 1.26; 95% confidence interval (CI), 1.12 to 1.41) and female gender (OR, 1.17; 95% CI, 1.06 to 1.30). [Figure presented] Conclusions: Nearly 1 in 14 opioid-naïve patients go on to persistent opioid use after URS for stone treatment. In light of these findings, urologists should consider alternatives to opioids for postoperative pain management.