Age a predictor of filling opiate prescriptions post-URS

A study examining opiate use after ureterscopy found that younger age and greater number of preoperative opiate prescriptions were associated with the filling of additional opiate prescriptions.

Approximately 1 in 8 patients who undergo ureteroscopy for kidney stones may require additional opiate prescriptions in the short term (within 30 days), and approximately 1 in 15 patients may require additional opiate prescriptions on a longer term period (over 60 days) after surgery, say researchers from Vanderbilt University, Nashville, TN. The research was presented at the 2018 AUA annual meeting in San Francisco.

“This population is at risk for opiate dependence. We were not surprised by our findings. It was interesting for us to find that younger age was a predictor for requiring immediate post-op additional opioid requirement,” said study investigator Caroline L. Kang, MD, PhD, urology resident at Vanderbilt University, working with Ryan S. Hsi, MD, and colleagues.

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Dr. Kang noted that surgical stone patients are commonly prescribed opioid medications perioperatively, but there has been little investigation into which patients require more opiate pain prescriptions. She and colleagues looked to see if there were any predictors of increased opiate requirement after ureteroscopy. They conducted a retrospective review of patients who underwent single-stage or final-stage ureteroscopy for stone disease at a tertiary referral center from January 2017 to June 2017.

For the study, the authors only included primary residents of Tennessee to allow for linkage to the Tennessee Controlled Substance Monitoring Database for opiate prescribing data. They collected demographic information including age, sex, race, body mass index, American Society of Anesthesiologists score, past stone surgery, and psychiatric history. They also evaluated surgical factors, including surgeon, operating times, presence of stent preoperatively, postoperative stent duration, access sheath use, and stone size.

The researchers performed univariate and multivariate analyses to determine predictors of additional prescription filled within 30 days, and persistent opiate use 60 days after ­ureteroscopy.

Next: 14 patients (7%) continued to use opiate medication more than 60 days postoperativelyDr. Kang said that among the 208 patients, 25 (12%) required an additional opiate prescription within 30 days after ureteroscopy. Additionally, 14 patients (7%) continued to use opiate medication more than 60 days postoperatively. The study revealed that younger age was associated with obtaining an additional opiate prescription within 30 days after ureteroscopy (p=.49).

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“None of the patients were what we would define as chronic opioid users. We defined chronic opioid users as requiring two or more opioid prescriptions 2 or more months before surgery,” Dr. Kang told Urology Times.

Several factors linked to extended use

She said no surgical factors were found to be associated with additional opioid prescriptions filled postoperatively. However, several factors were associated with extended opioid use. Dr. Kang said the number of opiate prescriptions preoperatively and the number of days of opiate prescribed preoperatively were positively associated with additional opiate prescription filled within 30 days and after 60 days postoperatively on univariate analysis. These associations were maintained even after the opiate variables were separately modeled with demographic factors, according to the authors.

“There is a little bit of variability in the way physicians are prescribing opioid medications, and so I think that not only do we have to educate our patients better but we as providers have to educate ourselves a little bit about what the issues are,” said Dr. Kang.