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UPJ INSIGHT: Postoperative Opioid Prescribing Following Outpatient Male Urethral Surgery: Evidence for Change
By: Bridget L. Findlay, MD, Mayo Clinic, Rochester, Minnesota; Elizabeth N. Bearrick, MD, Mayo Clinic, Rochester, Minnesota; Kevin J. Hebert, MD, University of Utah, Salt Lake City; Cameron J. Britton, MD, Mayo Clinic, Rochester, Minnesota; Matthew J. Ziegelmann, MD, Mayo Clinic, Rochester, Minnesota; Katherine T. Anderson, MD, Mayo Clinic, Rochester, Minnesota; Boyd R. Viers, MD, Mayo Clinic, Rochester, Minnesota; | Posted on: 09 Mar 2023
Findlay BL, Bearrick EN, Hebert KJ, et al. Postoperative opioid prescribing following outpatient male urethral surgery: evidence for change. Urol Pract. 2023;10(2):138-145.
Study Need and Importance
Surgeons play a central role in the opioid epidemic. Inappropriate overprescribing of opioids is a major contributor to this epidemic. While major headway has been made with enhanced recovery after surgery pathways following other major urological procedures, there is a dearth of data regarding male urethral surgery pain pathways.
What We Found
A total of 116 patients underwent outpatient anterior urethroplasty between August 2017 and January 2021. One-third of patients did not use opioids postoperatively, and nearly 78% of patients used ≤5 tabs (see Figure). Overall, the median number of opioid tablets used was 2, with a median of 8 tablets overprescribed. Those receiving tramadol reported a greater reduction in pain and higher satisfaction with their outpatient surgery experience. The only predictor for use of >5 tabs was preoperative opioid use (75% vs 25%, P < .01), although only 6 patients were considered opioid exposed.
Limitations
This was a single-surgeon experience, with involvement of a highly trained team who provide extensive perioperative counseling regarding expectations of surgery. Additionally, surveys were conducted by the care team at the postoperative visit, which was conducted 3 weeks following surgery. This inevitably introduces a large degree of recall bias given that patients were asked to comment on 72-hour postoperative pain scores. Surveys did not elucidate potential etiologies contributing to pain (ie, incisional, catheter related, or buccal mucosal graft harvest when applicable), nor did they capture potential postoperative complications, which could have contributed to greater narcotic utilization.
Interpretation for Patient Care
A multimodal, limited opioid pain management pathway using a small quantity of adjunctive opioid provides adequate pain control after outpatient urethroplasty. However, the ultimate goal is to optimize multimodal pain pathways and perioperative patient counseling in order to transition to a fully narcotic-free pathway.
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