8% of stone surgery patients use opioids long term

A sizable proportion of opioid-naïve patients who undergo stone surgery become chronic opioid users, according to a study conducted by urologists from Emory University, Atlanta.

The research also identified risk factors for prolonged opioid use, and therefore suggests targets for prevention, said Mohammed A. Said, MD, at the World Congress of Endourology and SWL in Paris.

Dr. Said and colleagues evaluated the incidence and predictors of prolonged opioid use in a population of 50,249 “opioid-naïve” adults (ages 18 to 64 years) undergoing shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. Patients included in the study had filled a prescription for an opioid within 7 days before or after their stone procedure and had 180 days of postoperative follow-up.

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Of this large cohort of patients, 8.1% became prolonged opioid users, defined as having filled another prescription for an opioid medication between 90 and 180 days after surgery. Multivariable logistic regression analysis identified substance or alcohol abuse, a history of mental health or pain disorders, and greater total oral morphine equivalent dosage at initial prescription as the strongest independent predictors of prolonged opioid use. Risk did not vary by type of stone surgery.

“The United States is in the midst of an opioid epidemic, and the problem is unique to this country. The findings of our study indicate that urologists are wrong if they think that prescribing opiates to patients undergoing stone surgery is not contributing to this issue,” said Dr. Said, urology resident at Emory University, working with Aaron Lay, MD, and colleagues.

“The onus is on us to find ways to prevent prolonged opiate use in this patient population. Our study supports the need to prescribe opioid alternatives and to raise awareness among prescribers for which patients are at highest risk for long-term use.”

The study was conducted by extracting information from the Truven MarketScan insurance claims database for the years 2009 through 2015. Patients were considered opioid-naïve and included in the analysis if they had not filled a prescription for an opioid within 1 week to 12 months prior to their stone surgery. Patients who received anesthesia 1 to 6 months after their stone surgery were excluded.

Additional variables associated with prolonged opioid use included female sex, multiple procedures, higher Charlson comorbidity index, and Southern region.

Claims database an ‘excellent resource’

Dr. Said noted that although there are other published reports in the surgical literature about persistent opiate use, there is little information about its prevalence among patients who undergo urologic procedures. A recent paper included patients who underwent urologic surgery, but it used ICD-9 codes to identify cases of opioid dependence and overdose.

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“ICD-9 codes are not an optimum way to capture the problem of chronic opioid use, which is really an acute diagnosis in people who are opioid-naïve. One of the strengths of our research is that the insurance claims database we used is an excellent resource for capturing prescription fills for the age group we studied,” he told Urology Times.

Dr. Said and colleagues are planning to apply the same methodology to investigate the rate of prolonged opioid use among patients undergoing other types of urologic surgery and to see if they can identify the minimum number of doses of an opioid medication that can be prescribed to allow patients to stay comfortable through the perioperative period and limit the potential for prolonged use.