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UPJ INSIGHT Interaction With the Health Care System After Nonopioid Discharge Strategy for Anterior Urethroplasty

By: John M. Myrga, MD, University of Pittsburgh Medical Center, Pennsylvania; Roger D. Klein, MD, PhD, University of Pittsburgh Medical Center, Pennsylvania; Christopher J. Staniorski, MD, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Robin V. Vasan, MD, University of Pittsburgh Medical Center, Pennsylvania; Shyam Patnaik, MD, University of Pittsburgh Medical Center, Pennsylvania; Paul J. Rusilko, DO, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania | Posted on: 20 Mar 2024

Myrga JM, Klein RD, Staniorski CJ, Vasan RV, Patnaik S, Rusilko PJ. Patient interaction with the health care system following a nonopioid discharge strategy for anterior urethroplasty. Urol Pract. 2024;11(2):416-421.

Study Need and Importance

Opioids continue to be a significant public health concern, with illicit narcotic usage as one of the leading causes of accidental death. Discharge opioid prescriptions have been recognized as a risk factor for persistent opioid use. A zero-opioid discharge after surgery can help to reduce this risk; however, many providers worry that this will increase patient phone calls, office visits, and requests for opioids. This has been studied in other urology populations, but patient interactions with the office after zero-opioid discharges have not been studied after anterior urethroplasty.

What We Found

From 2016 to 2023 we completed 500 anterior urethroplasties at our institution, 253 of which were discharged without an opioid prescription. There was no significant difference in office calls, office visits, emergency department visits, or need for an opioid prescription after discharge between those who were discharged with and without an opioid. Overall, by the end of our study period, 97% of patients were discharged without an opioid prescription and 94% were discharged on the day of surgery without any changes in interactions with the health care system (Figure).

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Figure. Increased utilization of same-day and zero-opioid discharge without an increase in phone calls to the office or emergency department (ED) visits.

Limitations

Our study is mainly limited because we did not collect patient-centered outcomes related to their postsurgical pain. Additionally, this is a single-surgeon and single-site study, which may limit the generalizability of our study. Finally, we do recognize that during this time other changes were occurring in the health care system which may impact opioid prescribing as well as same-day discharges.

Interpretation for Patient Care

Discharge opioids are unnecessary following most anterior urethroplasties. Prior studies have already shown patient tolerability in a zero-opioid discharge strategy. We have expanded these findings to show a zero-opioid discharge strategy also does not increase patient interaction with the health care system after discharge.

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