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UPJ INSIGHT Prolonged Opioid Use Following Bladder Tumor Resection for Opioid-naïve Patients

By: Benjamin Croll, MD, Emory University School of Medicine, Atlanta, Georgia; Dattatraya Patil, MBBS, Emory University School of Medicine, Atlanta, Georgia; Misaki Mason, BA, Emory University School of Medicine, Atlanta, Georgia; Vikram M. Narayan, MD, Emory University School of Medicine, Atlanta, Georgia; Viraj Master, MD, Emory University School of Medicine, Atlanta, Georgia; Christopher P. Filson, MD, MS, Emory University School of Medicine, Atlanta, Georgia; Shreyas S. Joshi, MD, Emory University School of Medicine, Atlanta, Georgia | Posted on: 20 Jul 2023

Croll B, Patil D, Mason M, et al. Prolonged opioid use following bladder tumor resection for opioid-naïve patients. Urol Pract. 2023;10(4):344-351.

Study Need and Importance

Rates of opioid abuse and overdose increased dramatically in recent years, with prescription opioids involved in nearly one-quarter of overdose deaths. In surgical patients, preoperative opioid use has been associated with prolonged hospitalization, higher complication rates, and higher opioid requirements after major surgery. Bladder cancer patients represent a high-risk group for persistent opioid use after initial exposure due to frequency of procedures and interface with health care providers.

What We Found

Insurance claims data of more than 80,000 patients were used to identify opioid-naïve patients with newly diagnosed bladder cancer. Those receiving post-transurethral resection of bladder tumor (TURBT) opioids had significantly increased odds of prolonged opioid use (see Figure), and those receiving the highest initial doses had the greatest odds of continuing to fill prescriptions in the months following initial TURBT. Odds of prolonged use have decreased in recent years, but the frequency of initial opioid prescribing is relatively unchanged. The mean oral morphine equivalent value when opioids are prescribed initially is 150.0, the equivalent of 20 pills of 5 mg oxycodone.

Figure. Odds of prolonged use of opioids in MarketScan commercial claims and Medicare-eligible groups, derived from multivariable regression analysis. Charlson Comorbidity Index (CCI) reference group is CCI 0. Year reference group is 2009–2012. CI indicates confidence interval; TURBT, transurethral resection of bladder tumor.

Limitations

Persistent use at 3–6 months does not imply substance abuse or dependence, but we know from prior studies that increased exposure is almost universally associated with poor health outcomes. While we did control for events under anesthesia and radical treatment within our multivariable analysis, a more in-depth understanding of the effect of TURBT and cystectomy on prolonged opioid use would add value to future study of this topic.

Interpretation for Patient Care

Insurance claims data of opioid-naïve bladder cancer patients have shown that an initial post-TURBT opioid prescription is strongly associated with continued opioid use in the months that follow diagnosis. The long-term implications of these prescriptions deserve thought and consideration, and additional research on methods to limit opioid use in bladder cancer patients is merited.

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