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UPJ INSIGHT Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses
By: Yuzhi Wang, MD*, Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan; Samantha Wilder, MD*, Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan; Monica Van Til, MS, University of Michigan Medical School, Ann Arbor; Ji Qi, MS, University of Michigan Medical School, Ann Arbor; Mahin Mirza, MPH, University of Michigan Medical School, Ann Arbor; Adam Gadzinski, MD, Comprehensive Urology, Beaumont Hospital, Royal Oak, Michigan; Thomas Maatman, DO, Michigan Urological Clinic, Grand Rapids; Brian R. Lane, MD, Corewell Health Hospital System, Grand Rapids, Michigan, Michigan State University College of Human Medicine, Grand Rapids; Craig G. Rogers, MD, Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan, For the Michigan Urological Surgery Improvement Collaborative *Co-first authors. | Posted on: 19 Jan 2024
Wang Y, Wilder S, Van Til M, et al. Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis. Urol Pract. 2024;11(1):125-134.
Study Need and Importance
Opioid prescription following surgery has played a role in the current opioid epidemic by increasing the risk of persistent opioid use and diverting unused medication into the community. While opioid-free discharge has been evaluated in other urologic procedures, there is limited knowledge of the safety and feasibility after nephrectomy. We evaluated practice-level variation in opioid prescribing following surgery for cT1 renal masses (T1RM) and examined the relationships between opioid-free discharge, postoperative emergency department (ED) visits, and readmissions.
What We Found
Of 414 patients who underwent surgery for T1RM across 15 practices in the Michigan Urological Surgery Improvement Collaborative-Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy (MUSIC-KIDNEY) from April 2021 to March 2023, 23.7% had opioid-free discharge. Practice level variation in rates of opioid-free discharge ranged from 6.7% to 55.0% (Figure). For patients prescribed opioids, the median number of pills was 10 (IQR 6-12); oxycodone 5 mg and hydrocodone-acetaminophen 5/325 were most commonly prescribed. Patients with cT1b masses were more likely to have opioid-free discharge (44.9% vs 32%, OR 0.44; 95% CI 0.22-0.89). Rates of 30-day ED visits (7.0% vs 3.1%) and readmissions (4.1% vs 2.0%) were lower in the opioid-free discharge group but did not reach statistical significance.
Limitations
Data collected regarding opioid prescription within MUSIC-KIDNEY are limited to the number of pills prescribed at discharge. We do not currently collect types of medication, dose, refills, usage, or disposal. Additionally, we do not currently collect data regarding nonnarcotic pain management, such as the use of regional anesthesia or nonsteroidal anti-inflammatory drugs.
Interpretation for Patient Care
MUSIC-KIDNEY data suggest opioid-free discharge is not associated with increased rates of postoperative ED visits or readmissions. There exists wide practice-level variation in opioid prescriptions following surgery for T1RM in the state of Michigan. Similar variation likely exists throughout the United States, and best surgical practice suggests reduction in opioid prescribing after nephrectomy.
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