Mp02-17 Predictors of Chronic Opioid Use in Bladder Cancer Patients Undergoing Radical Cystectomy: A Seer-Medicare Analysis

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety I (MP02)1 May 2024MP02-17 PREDICTORS OF CHRONIC OPIOID USE IN BLADDER CANCER PATIENTS UNDERGOING RADICAL CYSTECTOMY: A SEER-MEDICARE ANALYSIS Christopher J. Staniorski, Michelle Yu, Danielle Sharbaugh, Michael Stencel, John M. Myrga, Benjamin Davies, Jonathan G. Yabes, and Bruce L. Jacobs Christopher J. StaniorskiChristopher J. Staniorski , Michelle YuMichelle Yu , Danielle SharbaughDanielle Sharbaugh , Michael StencelMichael Stencel , John M. MyrgaJohn M. Myrga , Benjamin DaviesBenjamin Davies , Jonathan G. YabesJonathan G. Yabes , and Bruce L. JacobsBruce L. Jacobs View All Author Informationhttps://doi.org/10.1097/01.JU.0001008600.97797.3b.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have demonstrated high rates of new persistent opioid use following any urologic surgery. These studies have excluded patients with pre-operative opioid consumption. The aim of this evaluation is to determine patient and provider characteristics predictive of chronic opioid use following radical cystectomy for bladder cancer including non-opioid naïve patients. METHODS: Bladder cancer patients undergoing cystectomy from July 2007 to December 2015 were identified using the SEER-Medicare database. Opioid exposure was identified before and after cystectomy. Multivariable analyses were used to identify predictors of the primary outcomes: chronic opioid use (prescription 3-6 months after surgery) and post-operative opioid prescriptions (within 30 days of surgery). Secondary outcomes included physician prescribing practices and rates of chronic opioid use in their patient cohorts. RESULTS: A total of 1774 patients were included; 29% had prior opioid exposure. Compared to opioid-naïve patients, non-opioid naïve patients tended to be younger, belong to minority ethnic groups and live in less educated communities. The percentage of chronic post-operative use was 10% overall and 24% in non-opioid naïve patients. Adjusting for patient factors, opioid naïve individuals were less likely to develop chronic use (OR 0.23) while a 50-unit increase in oral morphine equivalent prescribed following surgery nearly doubled the likelihood of chronic use (OR 1.98). Practice factors such as hospital size, teaching affiliation and hospital ownership failed to predict chronic use. 29% of patients filled an opioid prescription post-operatively. Opioid naïve patients (OR 0.13) and those cared for at government hospitals (OR 0.59) were less likely to fill an opioid script along with those residing in the Northeast. Variability between physicians was seen in prescribing practices and rates of chronic use. CONCLUSIONS: Non-opioid naïve patients have higher rates of post-operative use than opioid-naïve patients. Physician prescribing practices play a role in chronic use, as initial prescription amount predicts chronic use even in non-opioid naïve patients. Significant physician variation in both prescribing practices and rates of chronic use suggest a role for standardizing practices. Download PPT Source of Funding: Dr. Bruce Jacobs is supported in part by the Shadyside Hospital Foundation. Dr. Michelle Yu was supported in part by the Tippins Foundation Scholar Award © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e19 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Christopher J. Staniorski More articles by this author Michelle Yu More articles by this author Danielle Sharbaugh More articles by this author Michael Stencel More articles by this author John M. Myrga More articles by this author Benjamin Davies More articles by this author Jonathan G. Yabes More articles by this author Bruce L. Jacobs More articles by this author Expand All Advertisement PDF downloadLoading ...