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Demus T, Lopategui DM, Vieweg J, Masel J, Bhandari A, Nieder AM. Variations in Opioid Use Following Robotic Radical Prostatectomy in South Florida. J Endourol 2022; 36:1532-1537. [PMID: 35856823 DOI: 10.1089/end.2022.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Opioid dependency has been a persistent issue in the United States over the past two decades. Increased efforts have been made to reduce opioid prescribing. Our objective was to quantify at-home opioid requirements following radical prostatectomy. Methods: Written questionnaires were administered to patients 1 week following robot-assisted laparoscopic radical prostatectomy (RALP). Patients provided data on opioid use, pain levels, and demographic characteristics. Results: Sixty-five patients were included. Median age (interquartile range [IQR]) was 69 (62-72) years. The majority were white (85%) and hispanic (67%). Prescriptions ranged from 6 to 15 pills of 5-mg oxycodone equivalents. Twenty-two percent (145/663) of the prescribed pills in the study were consumed. Fifty-four percent (35/65) of patients did not take opioids. Of the 30 patients who took opioids, median use (IQR) was 4.5 (3-6) pills. Forty-six percent (30/65) reported catheter-related pain. Patients who took opioids reported higher levels of pain. On generalized linear regression, younger age, lower levels of education, and living with a family member were factors associated with increased risk for opioid use (all p < 0.05). Conclusions: Despite the Florida Department of Health's restriction on narcotic prescriptions to 3-day supplies, opioids are still overprescribed in our region. The majority of patients do not require opioids after RALP, and patients who do require an opioid analgesic can be adequately managed with less than 6 pills of 5-mg oxycodone equivalents.
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Affiliation(s)
- Timothy Demus
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Diana M Lopategui
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Johannes Vieweg
- Department of Surgery, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Jonathan Masel
- Department of Urology, Memorial Healthcare System, Hollywood, Florida, USA
| | - Akshay Bhandari
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Alan M Nieder
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Koo K, Winoker JS, Patel H, Faisal F, Gupta N, Metcalf M, Mettee L, Meyer A, Pavlovich C, Pierorazio P, Matlaga BR. Evidence-Based Recommendations for Opioid Prescribing after Endourological and Minimally Invasive Urological Surgery. J Endourol 2021; 35:1838-1843. [PMID: 34107778 DOI: 10.1089/end.2021.0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Procedure-specific guidelines for postsurgical opioid use can decrease overprescribing and facilitate opioid stewardship. Initial recommendations were based on feasibility data from limited pilot studies. This study aims to refine opioid prescribing recommendations for endourological and minimally invasive urological procedures by integrating emerging clinical evidence with a panel consensus. METHODS A multistakeholder panel was convened with broad subspecialty expertise. Primary literature on opioid prescribing after 16 urological procedures was systematically assessed. Using a modified Delphi technique, the panel reviewed and revised procedure-specific recommendations and opioid stewardship strategies based on additional evidence. All recommendations were developed for opioid-naïve adult patients after uncomplicated procedures. RESULTS Seven relevant studies on postsurgical opioid prescribing were identified: four studies on ureteroscopy, two studies on robotic prostatectomy including a combined study on robotic nephrectomy, and one study on transurethral prostate surgery. The panel affirmed prescribing ranges to allow tailoring quantities to anticipated need. The panel noted that zero opioid tablets would be potentially appropriate for all procedures. Following evidence review, the panel reduced the maximum recommended quantities for 11 of the 16 procedures; the other 5 procedures were unchanged. Opioids were no longer recommended following diagnostic endoscopy and transurethral resection procedures. Finally, data on prescribing decisions supported expanded stewardship strategies for first-time prescribing and ongoing quality improvement. CONCLUSION Reductions in initial opioid prescribing recommendations are supported by evidence for most endourological and minimally invasive urological procedures. Shared decision-making prior to prescribing and periodic reevaluation of individual prescribing patterns are strongly recommended to strengthen opioid stewardship.
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Affiliation(s)
- Kevin Koo
- Mayo Clinic, 6915, 200 First St SW, Rochester, Minnesota, United States, 55905;
| | - Jared S Winoker
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Hiten Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Farzana Faisal
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Natasha Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Meredith Metcalf
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | | | - Alexa Meyer
- Johns Hopkins Medical Institutions, James Buchanan Brady Urological Institute, Baltimore, Maryland, United States;
| | - Christian Pavlovich
- Johns Hopkins, Urology , Suite 3200, Bldg 301, 4940 Eastern Ave, Baltimore, Maryland, United States, 21224;
| | - Philip Pierorazio
- Johns Hopkins Medical Institutions, James Buchanan Brady Urological Institute, 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland, United States, 21287;
| | - Brian R Matlaga
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
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