Data point to increase in opioid prescribing beyond immediate post-op period

Laura Gressler, MS, PhD

In this video, Laura Gressler, MS, PhD, discusses the background and notable findings from the Urology Practice paper, “National Long-Term Trends in Postoperative Opioid Prescribing in Ambulatory Urology Procedures.” Gressler is an assistant professor at the University of Arkansas for Medical Sciences College of Pharmacy in Little Rock.

Transcription:

Please describe the background for this study.

The study focuses on the trends in postoperative opioid prescribing after common urology ambulatory procedures. With over 60% of urological procedures performed in ambulatory settings, understanding these trends is crucial amid the ongoing opioid crisis in the United States. A 2016 JAMA study highlighted a concerning rise in opioid prescriptions following low-risk surgeries, showing a significant increase in both the proportion of patients receiving opioid prescriptions and the total amount prescribed. This underscores the importance of studying postoperative opioid use to prevent potential dependency and adverse outcomes. By analyzing trends in opioid prescribing practices and comparing factors such as stent vs no stent and open vs endoscopic procedures, we can better understand how to mitigate the risks associated with opioid use and ideally improve pain management protocols to enhance patient safety and health outcomes. So overall, this study aimed to comprehensively describe the postoperative patterns and trends in opioid and non-opioid prescribing. We also examined the cohort by approach and type of commonly performed urological ambulatory procedures to help delineate where best to focus future efforts in terms of mitigating narcotic prescriptions.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

There were 3 main notable findings from the study, and they include a significant overall decrease in opioid prescriptions from 32% in 2015 to 19% of 2021. Then we had a rise in the prescription of non opioid medications from 4.6 in 2015 to 9.5 in 2021, and then we found higher rates of opioid prescriptions for open procedures compared to endoscopic ones. A surprise finding was the increase in opioid fulfillment beyond the 7-day postoperative period, which was really unexpected, and this indicates a need for more specific guidelines addressing pain management beyond that immediate postoperative period.

The abstract mentions a need for guidelines for narcotic prescribing habits beyond the 7-day postsurgical period; could you provide some information on what would ideally be contained in such guidelines?

I came up with 5 different things. [These include] specific criteria for assessing the patient's pain levels and determining the actual necessity of continued opioid use, the use of nonopioid alternatives, which, of course, I just mentioned, we saw a rise in that. That's good, but we need formal recommendations for nonopioid pain management strategies and medications. Monitoring follow-up is always helpful, so procedures for monitoring patients' opioid use and scheduled follow-up appointments to reassess pain management needs, because those may change over time. Patient education is always helpful, so guidelines for educating patients on the risks of long-term opioid use and the safe disposal also of unused medications so they don't go into the wrong hands. And then provider coordination, so strategies for coordinating pain management among different health care providers to prevent overprescription because a lot of our patients also that we analyzed had previous pain conditions, and so making sure that we coordinate with the other providers to see, how are they dealing with that pain, are they managing that? And then, how does that correspond with the current procedure that they're undergoing?

What is the take-home message for the practicing urologist?

I would say that while postoperative opioid prescribing has decreased significantly within the 7-day period following ambulatory urological procedures, there's still a critical need for additional guidelines to manage pain beyond that period, and urologists should focus on utilizing nonopioid pain management strategies, which it seems like they're doing with the increase of nonopioid pain management prescribing, and ensure thorough patient education and follow-up to mitigate the risk of prolonged opioid use.

Is there anything you would like to add?

As a researcher, I'd like to emphasize the need for further research into the factors driving opioid prescriptions beyond the immediate postoperative period. There should be concerted efforts to develop and implement comprehensive guidelines that address these factors, ensuring that patients receive effective pain management while minimizing the risk of opioid dependency. So while we do see a decrease in opioid use, we still want to make sure that the pain is addressed and that it's addressed correctly. This study really highlights the progress made in reducing opioid use, but also underscores the ongoing challenges that require targeted interventions. And then finally, we need better data to fully assess this issue, including capturing over-the-counter medication use and other potential confounders, such as provider or patient preferences, because these factors can significantly affect our ability to comprehensively understand and actually address postoperative opioid use.