MP48-01 THE EFFECT OF OPIATES ON PATIENT REPORTED OUTCOMES AFTER URETEROSCOPY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP48-01 THE EFFECT OF OPIATES ON PATIENT REPORTED OUTCOMES AFTER URETEROSCOPY Andrew Higgins, Russell Becker, Stephanie Daignault-Newton, Golena Fernandez Moncaleano, John Ludlow, Hector Pimentel, Brian Seifman, David Wenzler, Bronson Conrado, Karla Witzke, and Khurshid Ghani Casey Dauw Andrew HigginsAndrew Higgins More articles by this author , Russell BeckerRussell Becker More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , John LudlowJohn Ludlow More articles by this author , Hector PimentelHector Pimentel More articles by this author , Brian SeifmanBrian Seifman More articles by this author , David WenzlerDavid Wenzler More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Karla WitzkeKarla Witzke More articles by this author , and Khurshid Ghani Casey DauwKhurshid Ghani Casey Dauw More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The outcomes of kidney stone surgery have long been focused on stone-free rates and safety, yet patient reported outcomes (PRO) are often lacking. In 2018 the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) group initiated a pain optimization pathway using an opioid-free multi-modal pain regimen. This has resulted in a decline in opioid prescription rates after ureteroscopy (86 to 19%). We used a comprehensive PRO system to understand the initiative’s impact on patients’ experiences of treatment pain and satisfaction. METHODS: MUSIC ROCKS instituted its patient-reported outcomes (PRO) program in 2020 which included an assessment of patient pain (PROMIS Pain Intensity short form and Pain Interference short form) and overall treatment satisfaction (ICIQ-S). This system is automated and distributes questionnaires preoperatively and at 7-10 days and 4-6 weeks following ureteroscopy (URS). We compared patients who were prescribed opiates after URS to those who were not. After adjusting for observed demographic differences (age, gender, pre-stent status, stone location/size, and preoperative pain), we evaluated PRO pain intensity and interference with linear mixed models. A clinically meaningful difference in PROMIS scores is 2.5-3.5 points. Treatment satisfaction scores were compared with Wilcoxon rank tests. RESULTS: A total of 292 patients completed all questionnaires (258 non-opioid and 34 opioid). There was no significant difference between non-opioid and opioid cohorts with regards to age (60 vs 59 years), gender (50 vs 53% male), pre-stenting status (76 vs 65%), stone location (64 vs 59% ureteral), and stone size (8.0 vs 7.2 mm). After adjustment, there was no significant difference in preoperative pain intensity scores between the groups at pre-URS (p=0.06), 7-10 days postop (p=0.87), and 4-6 weeks postop (p=0.99, Figure). Pain interference followed a similar pattern, with no significant differences observed at any timepoint. There was no difference in satisfaction scores, as measured both 7-10 days (p=0.46) and 4-6 weeks (p=0.47) after URS. CONCLUSIONS: Rates of opiate prescription have declined after URS in Michigan. Using a novel PRO system, we confirmed that utilization of opioid-free pathways has not resulted in increased pain nor decreased patient satisfaction. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e654 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Higgins More articles by this author Russell Becker More articles by this author Stephanie Daignault-Newton More articles by this author Golena Fernandez Moncaleano More articles by this author John Ludlow More articles by this author Hector Pimentel More articles by this author Brian Seifman More articles by this author David Wenzler More articles by this author Bronson Conrado More articles by this author Karla Witzke More articles by this author Khurshid Ghani Casey Dauw More articles by this author Expand All Advertisement PDF downloadLoading ...