Login to Access Video or Poster Abstract: MP75-04
Sources of Funding: T32-CA180984 from the National Cancer Institute

Introduction

Opioid abuse has become an epidemic in the United States. Surgical episodes account for 40% of all opioids prescribed and thus, surgeons are uniquely positioned to control the supply of available opioids. Given the high incidence of nephrolithiasis, we sought to characterize the variation in opioid prescribing among a national cohort following extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy with lithotripsy (URS).

Methods

We identified patients who underwent outpatient ESWL and URS between 2012 and 2014 using the de-identified Clinformatics^TM Data Mart Database (OptumInsight, Eden Prairie, MN). The database contains administrative health and pharmacy claims from a large, national US health insurer. We limited our cohort to patients that had no concurrent procedures and had not filled an opioid prescription in the 6 months prior to their procedure. We calculated the dose and type of opioids, standardized to morphine milligram equivalents (MME), prescribed within 7 days of the procedure. For urologists with a minimum of 10 cases and 3 opioid prescriptions we quantified the variation in surgeon prescribing patterns.

Results

We identified 22,577 patients (12,942 ESWL, 9,635 URS) treated during our study period. Forty percent of ESWL and 43% of URS patients filled an opioid prescription following their procedure. Among those patients, the median dose was 150 MME (interquartile range [IQR] 128-225). This corresponds to twenty 5mg oxycodone tablets with a range of 17 to 30 tablets. Hydrocodone (57%) was the most frequently prescribed opioid for ESWL and oxycodone (59%) for URS. Surgeons varied widely in the average dose of opioids prescribed, ranging from 89 to 675 MME (p<0.001), or eleven to ninety 5mg oxycodone tablets (Figure).

Conclusions

Most patients did not fill an opioid prescription after ESWL or URS. There was no significant difference between ESWL and URS in terms of frequency or amount of opioids prescribed. There was wide variation in opioid prescribing at both the patient and urologist level. Given that these patients were opioid naive, patient variables are not likely to account for this variation. As such, urologists appear to be well positioned to reduce excess opioid prescribing. _x000D_

Funding

T32-CA180984 from the National Cancer Institute