PD58-05 CONTRIBUTING TO A CRISIS? DEFINING NATIONAL PATTERNS IN OPIOID PRESCRIBING AFTER OUTPATIENT VASECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2017PD58-05 CONTRIBUTING TO A CRISIS? DEFINING NATIONAL PATTERNS IN OPIOID PRESCRIBING AFTER OUTPATIENT VASECTOMY Gregory Auffenberg, Rodney Dunn, Yongmei Qin, Tyler Winkelman, James Dupree, Brent Hollenbeck, Ted Skolarus, David Miller, and Tudor Borza Gregory AuffenbergGregory Auffenberg More articles by this author , Rodney DunnRodney Dunn More articles by this author , Yongmei QinYongmei Qin More articles by this author , Tyler WinkelmanTyler Winkelman More articles by this author , James DupreeJames Dupree More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , Ted SkolarusTed Skolarus More articles by this author , David MillerDavid Miller More articles by this author , and Tudor BorzaTudor Borza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2620AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prescribing surplus opioids after minor surgery can increase risks of misuse in the community. Surgeons may be well positioned to decrease these risks through modification of post-operative prescribing practices. In this context, we define national practice patterns and surgeon-specific differences in opioid prescriptions after outpatient vasectomy. METHODS Using the de-identified ClinformaticsTM Data Mart Database (OptumInsight, Eden Prairie, MN) from a large, national US health insurer, we identified patients who underwent outpatient vasectomy between 1/2012 and 12/2014. Men were excluded if they received any concurrent operation or filled an opioid prescription in the 6 months prior to vasectomy. For this cohort, we determined the proportion of men filling an opioid prescription in the 7 days after surgery, and evaluated the type and quantity of opioids prescribed, standardized to morphine milligram equivalents (MME). Finally, we quantified surgeon-specific variation in MMEs prescribed for surgeons with 10 or more patients in the cohort, and at least 5 filling an opioid prescription post-operatively. RESULTS We identified 25,102 men who received a vasectomy during the study interval. Among this group, 10,442 (41.6%) patients filled an opioid prescription after surgery. Hydrocodone was the most common medication, comprising 66.7% of filled prescriptions. The median number of MMEs prescribed was 112.5 [IQR 82.5-150]; equivalent to twenty-three, 5 mg hydrocodone tablets per prescription [IQR 16.5-30 tablets/ prescription]. Across 360 surgeons meeting criteria for surgeon-specific analysis, the average number of MMEs prescribed after vasectomy varied substantially (range: 29.2-390 MMEs (p<0.001); corresponding to a range of six to seventy-eight, 5 mg hydrocodone tablets per prescription (Figure). CONCLUSIONS Less than half of men fill an opioid prescription following vasectomy, indicating that non-opioid pain strategies may be sufficient for most patients. Nonetheless, surgeon-specific analyses revealed a 13-fold difference in the average quantity of opioids supplied. Because patient necessity is unlikely to entirely explain this variability, efforts to reduce excess opioid prescribing after vasectomy are warranted. © 2017FiguresReferencesRelatedDetailsCited byWebber R, Patzkowski M, Costantino R, Velosky A, Lee V, Cyr K, Harris L, Scott-Richardson M and Highland K (2022) Procedural Benzodiazepine and Post-Vasectomy Opioid and Nonopioid Prescribing Variation in a Large Health Care SystemUrology Practice, VOL. 9, NO. 5, (431-440), Online publication date: 1-Sep-2022. Volume 197Issue 4SApril 2017Page: e1128-e1129 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Gregory Auffenberg More articles by this author Rodney Dunn More articles by this author Yongmei Qin More articles by this author Tyler Winkelman More articles by this author James Dupree More articles by this author Brent Hollenbeck More articles by this author Ted Skolarus More articles by this author David Miller More articles by this author Tudor Borza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...