Abstract
Objectives: This study aimed to better understand differences in the total days’ supply and fills of common opiates following urologic procedures. Materials and Methods: The Truven Health MarketScan® database was used to extract CPT codes from adults 18 years or older who underwent a urologic procedure with 90-day follow-up from 2012–2015 within the Austin–Round Rock, Texas metropolitan service area. A multivariate analysis and first hurdle modeling with a logistic outcome for any opiates was used to (1) assess differences in opioid prescribing patterns, (2) investigate opioid prescription outcomes, and (3) explore variability among opiate prescription patterns across seven urologic procedure categories. Results: Among the 2312 patients who met the inclusion criteria, 23.7% received an opiate, with an average total day’s supply of 6.20 (range 2.61–10.59). The proportion of patients receiving opiates varied significantly by procedure type (p = 0.028). Patients that had reconstructive procedures had the highest proportion of any opiates and the highest number of mean opiate prescriptions among the seven procedure categories (42% received opiates, p = 0.028, mean opiate prescriptions were 1.0 among all patients, p = 0.026). After adjustments, the multivariate analysis demonstrated that patients undergoing reconstructive procedures filled more opiate prescriptions (odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.00–3.50, p = 0.05) compared to other subcategories. Of those that received opiates, reconstructive patients had a shorter time to fills (mean −18.4 days, CI −8.40 to −28.50, p < 0.001). Conclusion: Patients undergoing reconstructive procedures are prescribed and fill more opiates compared to other common urological procedures. The standardization and implementation of postoperative pain regimens may help curtail this variability.
Highlights
There are more than 650,000 opioid prescriptions written each day in the United States, equating to nearly one prescription for every adult annually in the general population [1,2].From 2000–2018, nearly a quarter of a million people have died in the United States from overdoses related to prescription opioids, with a five-fold increase in overdose deaths during this time period [3–5]
Our results suggest that there is a difference in opiate prescription patterns among different urological procedures in a major metropolitan statistical area in central Texas
Our results suggest that there are factors related to patients receiving reconstructive procedures that lead to elevated opioid prescription patterns when compared to the other procedure types investigated in our study
Summary
There are more than 650,000 opioid prescriptions written each day in the United States, equating to nearly one prescription for every adult annually in the general population [1,2]. From 2000–2018, nearly a quarter of a million people have died in the United States from overdoses related to prescription opioids, with a five-fold increase in overdose deaths during this time period [3–5]. Despite the growth in opioid prescription volume, the amount of pain that Americans report has not decreased significantly [5]. The increase in opiate prescription volume is partially attributed to the discrepancy in opioid prescription patterns among practitioners and is influenced by factors such as physician personal preference, variability between healthcare systems, state legislation, and regional opiate availability [6,7]. Many studies have reported that surgical opioid prescription patterns exceed state guidelines and vary between facilities and regions [6,9,10]
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