PD05-03 OPIATE OMISSION AFTER URETEROSCOPY DOES NOT LEAD TO INCREASED EMERGENCY DEPARTMENT VISITS: RESULTS FROM A STATEWIDE QUALITY IMPROVEMENT COLLABORATIVE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I (PD05)1 Apr 2020PD05-03 OPIATE OMISSION AFTER URETEROSCOPY DOES NOT LEAD TO INCREASED EMERGENCY DEPARTMENT VISITS: RESULTS FROM A STATEWIDE QUALITY IMPROVEMENT COLLABORATIVE Scott Hawken*, Spencer Hiller, Kavya Swarna, Jill Slayton, Conrad Maitland, David Wenzler, John Hollingsworth, Khurshid Ghani, Casey Dauw, and for the Michigan Urological Surgery Improvement Collaborative Scott Hawken*Scott Hawken* More articles by this author , Spencer HillerSpencer Hiller More articles by this author , Kavya SwarnaKavya Swarna More articles by this author , Jill SlaytonJill Slayton More articles by this author , Conrad MaitlandConrad Maitland More articles by this author , David WenzlerDavid Wenzler More articles by this author , John HollingsworthJohn Hollingsworth More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Casey DauwCasey Dauw More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000825.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Emergency department (ED) visits after ureteroscopy (URS) are common and are often due to postoperative pain. As a part of a statewide quality initiative to reduce ED visits, we sought to determine if opiate omission following URS is associated with unintended consequences, such as increased ED visits. METHODS: The Michigan Urological Surgery Improvement Collaborative’s Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) initiative was established in 2016. It is comprised of urologists across the state whose goal is to improve the care of patients with stone disease. We identified patients that underwent primary URS and examined quarterly trends in postoperative opiate prescription. Variation in opiate prescribing was assessed at the practice level. Using demographic, clinical, and operative data, we constructed a multivariable model to define risk factors for opiate prescription. After adjusting for patient and practice-level factors, we determined whether opiate omission was associated with postoperative ED visits within 30 days of surgery. RESULTS: We identified 9,268 patients who underwent URS (2016-2019). Post-URS opiate prescriptions have shown an absolute decline of 43.4% since the inception of MUSIC ROCKS (Figure). There was wide variation in practice-level opiate use (8.8% to 98.7%, p<0.01). The odds of receiving an opiate were higher in males (OR 1.32, 95%CI 1.17-1.49, p<0.01), those with a stent (OR 1.72, 95%CI 1.49-1.99, p<0.01), or a diagnosis of chronic pain (OR 1.68, 95%CI 1.01-2.66, p=0.04). Those less likely to receive opioids were older (OR 0.99, 95%CI 0.98-0.99, p<0.01), had greater comorbidity (OR 0.82, 95%CI 0.69-0.98, p=0.03), and were prescribed an NSAID (OR 0.23, 95%CI 0.19-0.28, p<0.01). Omission of opiates following URS was not associated with increased ED visits (OR 0.83, 95%CI 0.67-1.04). CONCLUSIONS: Since establishment of a statewide quality improvement program in Michigan, opiate prescriptions following URS have declined substantially without an increase in ED visits. Patient factors and practice variation contribute to the risk of receiving an opiate underscoring the need for continued efforts in this area. Source of Funding: funding from Blue Cross Blue Shield of Michigan © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e84-e85 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Scott Hawken* More articles by this author Spencer Hiller More articles by this author Kavya Swarna More articles by this author Jill Slayton More articles by this author Conrad Maitland More articles by this author David Wenzler More articles by this author John Hollingsworth More articles by this author Khurshid Ghani More articles by this author Casey Dauw More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...