Abstract: PD01-09
Sources of Funding: None

Introduction

Narcotic prescribing patterns among physicians are receiving increased scrutiny, especially in states with high rates of drug abuse, such as North Carolina (NC). Patients with interstitial cystitis (IC)/bladder pain syndrome (BPS) are often provided narcotic therapy as part of a multimodal approach. Some of these patients may progress to cystectomy with urinary diversion (CWUD), but the impact upon long-term narcotic usage is unknown. We sought to determine the rate of persistent narcotic usage among IC/BPS patients undergoing CWUD.

Methods

An IRB-approved, prospectively collected single-surgeon database of IC/BPS patients who underwent CWUD from April 2010 to April 2016 was reviewed. Patients residing outside of NC were excluded. The remainder was queried via the North Carolina Controlled Substance Reporting System, which tracks all statewide dispensing of Schedule II-V substances. Cases were evaluated for the total amount of dispensed substances for the year prior to surgery and up to one year postoperatively, and converted to oral morphine equivalents. The difference in usage was compared by a Student’s 2-tailed t-test. Prescriptions filled within the first 30 days after surgery were excluded.

Results

32 patients met inclusion criteria, 84.3% of which had additional chronic pain disorders. Mean age was 55 years and mean preoperative anesthetic bladder capacity was 433 cc. Mean follow-up was 744 days. All patients were narcotic users preoperatively. Following CWUD, 25/32 (78%) patients filled database-registered prescriptions after the 30-day postoperative window. The most commonly dispensed oral narcotics were oxycodone and hydrocodone. Compared to preoperative totals, mean postoperative morphine equivalents decreased by 52.6% (NS; p = 0.254). Two patients initiated therapy with fentanyl patches in the year after surgery.

Conclusions

Following CWUD for IC/BPS, 78% of patients can be expected to continue narcotic therapy. Although mean usage appears to decrease postoperatively, the difference was not significant, and may be related to the prevalence of coexisting pain disorders in this population. This information is critical to setting patient expectations and for educating state medical boards. Future work is necessary to determine whether postoperative substance usage is potentially related to withdrawal and if alternative regimens are feasible.

Funding

None