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UPJ INSIGHT No-Opioid Discharge Following Artificial Urinary Sphincter Placement and Health Care System Burden
By: John Myrga, MD, University of Pittsburgh Medical Center, Pennsylvania; Roger Klein, MD, PhD, University of Pittsburgh Medical Center, Pennsylvania; Robin Vasan, MD, University of Pittsburgh Medical Center, Pennsylvania; Chris Staniorski, MD, University of Pittsburgh Medical Center, Pennsylvania; Paul Rusilko, DO, University of Pittsburgh Medical Center, Pennsylvania | Posted on: 20 Mar 2024
Myrga J, Klein R, Vasan R, Staniorski C, Rusilko P. No-opioid discharge following artificial urinary sphincter placement does not significantly increase health care system burden. Urol Pract. 2024;11(2):333-338.
Study Need and Importance
Prescription of opioid analgesics following urologic surgery confers an increased risk of opioid dependence to patients and their communities. Concern for increased postoperative health care utilization remains a barrier to the adoption of no-opioid discharge strategies. To date, no studies have been performed to assess the difference in rate of office communications, unplanned clinic visits, or presentation to an emergency department between patients who did and did not receive opioid prescriptions following artificial urinary sphincter (AUS) placement.
What We Found
A retrospective dataset comprising 101 patients undergoing AUS placement or 3-component revision included 56 patients who received an opioid prescription on discharge and 45 who did not. No differences in age, race, BMI, or operative time were seen between these groups (Table). There was no significant increase in the rate of postoperative phone calls, messages, unplanned office visits, or emergency department visits within 90 days of AUS implantation/revision between the two cohorts (Table).
Table. Comparison of Baseline Patient Characteristics and Postoperative Health Care Utilization Between Patients Who Did and Did Not Receive a Discharge Prescription for an Opioid Analgesic Following Artificial Urinary Sphincter Placement or Revision
| Characteristics | Zero-opioid discharge (n = 45) |
Opioid on discharge (n = 56) |
P value |
|---|---|---|---|
| Age, median (IQR), y | 70 (66-72) | 69 (65-75) | .81 |
| BMI, median (IQR), kg/m2 | 29 (26-34) | 27 (25-31) | .07 |
| Operative time, median (IQR), min | 98 (85-110) | 105 (86 -120) | .19 |
| Total oral morphine equivalents, median (IQR) | 0 | 60 (37-100) | - |
| Distance from hospital, median (IQR), mi | 22 (11-67) | 43 (20-80) | .051 |
| White race, No. (%) | 38 (84) | 54 (96) | .07 |
| Preoperative opioid naïve, No. (%) | 39 (88) | 54 (96) | .13 |
| Office communications, No. (%) | 14 (31) | 19 (34) | .83 |
| Unplanned office visits, No. (%) | 16 (36) | 13 (23) | .19 |
| Emergency department visits, No. (%) | 9 (20) | 7 (12) | .41 |
Limitations
The single-surgeon, retrospective nature of our dataset does not account for differences in the technical expertise of the surgeon or patient counseling between patients who received a postoperative opioid prescription and those who did not. Further, prescription of opioids at the discretion of the attending physician may have led to differences between the patient populations that were not accounted for in our analysis. Finally, our study did not assess patient-reported outcomes.
Interpretation for Patient Care
Urologic providers should not use concern for increased health care utilization as a rationale for the routine prescription of postoperative opioids following AUS placement. The decision to prescribe opioids should be made on a patient-specific basis to minimize morbidity associated with postoperative discomfort and the future risk of opioid dependence.
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