Mp40-12 Opioid Prescribing After Stone Surgery in Wisconsin Remains High: Evidence That Pre-Operative Exposure to Opioids Leads to Higher Post-Operative Prescribing

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I (MP40)1 May 2024MP40-12 OPIOID PRESCRIBING AFTER STONE SURGERY IN WISCONSIN REMAINS HIGH: EVIDENCE THAT PRE-OPERATIVE EXPOSURE TO OPIOIDS LEADS TO HIGHER POST-OPERATIVE PRESCRIBING Emily C. Serrell, Jessica R. Schumacher, Manasa Venkatesh, Randi Cartmill, Jacob Stevens, Robert Tyllo, Margaret Knoedler, Stephen Nakada, and Tudor Borza Emily C. SerrellEmily C. Serrell , Jessica R. SchumacherJessica R. Schumacher , Manasa VenkateshManasa Venkatesh , Randi CartmillRandi Cartmill , Jacob StevensJacob Stevens , Robert TylloRobert Tyllo , Margaret KnoedlerMargaret Knoedler , Stephen NakadaStephen Nakada , and Tudor BorzaTudor Borza View All Author Informationhttps://doi.org/10.1097/01.JU.0001008788.18007.3f.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In opioid naïve patients, experts recommend prescribing 0-10 opioid doses following common kidney stone procedures. However, it is unclear to what extent of these patients are exposed to narcotics preoperatively. We aim to quantify pre- and post-operative opioid prescribing in patients undergoing ureteroscopy (URS) and shock wave lithotripsy (SWL) and measure the association between pre-operative opioid exposure and post-operative prescribing. METHODS: We used the Wisconsin Health Information Organization database, which captures>75% of Wisconsin's population. We collected demographic data on adult patients undergoing URS and SWL 1/1/2018-12/31/2021. We evaluated pre- and post-operative opioid prescriptions, quantified exposure in morphine milligram equivalents (MME), and compared prescribing characteristics between opioid naïve and opioid exposed patients (defined as those with a filled prescription in 6 months before surgery). RESULTS: We identified 14,075 patients (10,886 URS, 3,189 SWL). Overall, 45% of patients filled a pre-operative prescription with similar proportion for the URS (45%) and SWL (45%). The majority of fills occurred in the 3 weeks prior to surgery (63%; Figure 1) at a median of 16 days (IQR 8-40) with only 18% fills occurring>8 weeks prior. Patients filled 1 prescription (IQR 1-3) with a median dose of 150 MME (IQR 90-337; equivalent to 20 tabs 5mg oxycodone). Post-operatively, 50% of patients filled a prescription with a median first dose of 120 MME (IQR 75-210; 16 tabs 5mg oxycodone). Opioid exposed patients had a significantly higher 2-week post-operative dose (171 vs 131 MME (23 vs 17 tabs 5mg oxycodone), p<0.001) and number of prescriptions (1.43 vs 1.35, p<0.001). CONCLUSIONS: Nearly half of patients undergoing kidney stone procedures are not opioid naïve, with most filling a prescription in the three weeks before surgery. After surgery, more than half of patients filled an opioid prescription. Both pre- and post-operative opioid prescribing remains twice higher than guideline recommendations. Patients with prior opioid exposure had significantly higher number and dosage of opioid prescriptions. Incorporating opioid exposed patients into guideline recommendations is imperative to inform real world care. Download PPT Source of Funding: K08 from AHRQ K08HS028474 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e668 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Emily C. Serrell More articles by this author Jessica R. Schumacher More articles by this author Manasa Venkatesh More articles by this author Randi Cartmill More articles by this author Jacob Stevens More articles by this author Robert Tyllo More articles by this author Margaret Knoedler More articles by this author Stephen Nakada More articles by this author Tudor Borza More articles by this author Expand All Advertisement PDF downloadLoading ...