(283) Managing Patient Pain Expectations in Buried Penis Repair: An Opportunity for Quality Improvement

Abstract

Abstract Introduction Buried penis repairs are complex cases often requiring collaboration between urology and plastic surgery. These surgeries are often extensive, can require split thickness skin grafting (STSG) of the penile shaft, negative pressure wound vac, and have high incidence of wound complications. There are no studies that evaluate perioperative pain in patients undergoing buried penis repair. Objective In the ongoing opioid epidemic, we aim to evaluate patient risk factors and peri-operative elements that can minimize opioid use in buried penis repair. Methods A retrospective chart review of patients who underwent buried penis repair from 7/2012 to 7/2021 was performed. Patient demographics, comorbidities and perioperative data were collected, including history of chronic pain, indications, intraoperative findings, perioperative pain control, and 30-day post-operative encounters. The state’s prescription monitoring program was used to verify use of prescription pain medications prior to surgery, at discharge, and refills, collected as Morphine Equivalent Dose (MED). Results A total of 63 patients were included in analysis. Mean age was 55.9 ± 14.4 with a mean pre-op BMI of 41.99 ± 9.17. 75% required a STSG on the penile shaft. The median discharge MED (dMED) was 150, ranging from 0 to 450 MED. 36.5% required opioid refills within 30 days of surgery. This cohort was further separated into two groups: patients who were discharged with < 150 MED (A) vs ≥ 150 MED (B), based on the median dMED. Three patients were excluded: two were on home opioids, one discharged on benzodiazepines. There were no differences in age, pre-op BMI, medical comorbidities (CAD, PVD, HTN, DM, psychiatric history) or history of chronic pain between the cohorts. Surgery for improvement of hygiene was more likely to have higher dMED, 40.7% (A) vs 69.7% (B), p=0.017. Other surgical indications (sexual health, voiding) showed no difference. Prior surgeries (urethral procedures, circumcision) were statistically more likely to require higher dMED, 48.1% (A) vs 72.7% (B), p=0.033. If a penile skin graft was required, there was no difference in graft size and dMED. Twenty-six patients had a hospital managed wound vac, while 19 patients had home wound vacs, but there was no difference in dMED. Although there was no standardized hospital pain regimen, patients on scheduled acetaminophen were more likely to have a lower dMED, 70.3%(A) vs 42.4% (B), p=0.021. 40.7% (A) vs 36.4% (B) of patients required opioid refills within 30 days of surgery, showing no statistical significance. Conclusions For patients who are embarking on buried penis repair, providers can pre-operatively set pain control expectations, especially for those who require repair for hygiene purposes or have had prior urologic reconstructive surgery. In the perioperative setting, this data supports the use of non-opioids, specifically scheduled acetaminophen, to minimize opioid prescribing at discharge. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific