Dr. Staniorski on trends in opioid use following radical cystectomy

In this interview, Christopher J. Staniorski, MD, highlights the background and key findings from the study, “Predictors of chronic opioid use in bladder cancer patients undergoing radical cystectomy: A SEER-Medicare Analysis,” which he presented at the 2024 American Urological Association Annual Meeting in San Antonio, Texas. Staniorski is a fifth-year urology resident at the University of Pittsburgh Medical Center in Pennsylvania.

Video Transcript:

Could you describe the background for this work?

We know that there is a high risk of persistent opioid use following urologic surgery. Specifically, from prior work, we know that that risk is about 10% for patients undergoing cystectomy. We wanted to look a little bit more into this population, largely because there have been a couple of exclusions that we considered important. Number 1 is that a lot of the prior studies didn't include patients who have had opioids in the couple of months prior to their cystectomy. Also, most of this work has been done in private insurance databases. So, we chose to do this in SEER, which is a public insurance database that also includes some things like physician analyses, as well as variables such as hospital size and characteristics that might affect opioid use after surgery.

What were the key findings from this study?

We found that, in our study, approximately 25% of patients who have had opioids prior to their cystectomy will continue to use opioids 3 to 6 months after their surgery. This was compared to about 10% in the overall population. On multivariate analysis, this did show that having opioids prior to your surgery would put you at more risk for opioids after surgery, which isn't necessarily surprising. But even when controlling for this and looking at the amount of opioids that physicians prescribe to each of these patients, the higher opioid prescriptions by physicians still impacted their overall rates and likelihood of developing persistent use of opioids 3 months after their procedures.

Another key finding is that we looked at physicians who were doing these procedures, and we looked at the rates that each of them within their cohort has of persistent use. We found that this varied; about a third were over 10% of their cohort had persistent use after surgery. However, the other 50% to 60% had no patients that developed persistent use. So, a key finding could be the variability in the physician practice as well.

This transcription has been edited for clarity.