Inpatient Opioid Use Poorly Predicts Discharge Opioid Prescriptions Following Nephrectomy.

Abstract

The overprescribing of opioids after urological surgery places patients at risk for opioid overuse and dependency. However, few guidelines exist to help urologists consistently prescribe appropriate quantities of pain medications. We sought to characterize the variation in opioid prescribing habits at time of discharge following nephrectomy. We performed a retrospective review of patients who underwent partial or radical nephrectomy between November 2016 and May 2018 at an academic medical center. We reviewed patient, procedure and provider level variables potentially associated with high opioid use. Daily inpatient opioid use and discharge opioid prescriptions were tabulated in oral morphine equivalents. We identified 173 eligible patients who used a daily average of 36 oral morphine equivalents during their hospitalization weaning to 27 oral morphine equivalents on the day of discharge. All but 2 patients were prescribed opioids at discharge with an average of 367 oral morphine equivalents per prescription (SD 284). On multiple linear regression preoperative opioid use, open vs minimally invasive approach, length of stay and last day opioid use were associated with discharge oral morphine equivalents (R2=0.51, p <0.05). Patients were discharged with excessive opioids with an average discharge prescription equivalent to 13.6 times the last inpatient day's use. When combined with other potential predictors of discharge opioid prescriptions inpatient use accounts for less than 50% of the variance between prescriptions. Systems are needed to help minimize variability in opioid prescribing practices and reduce the overall quantity prescribed.