Post-Operative Opioid Prescribing Practices and Trends Among Urology Residents in the United States.

James J Kelley,Samuel Deem,Nathan E Hale,Sharon Hill

doi:10.7759/cureus.12014

Abstract

Introduction: With the opioid epidemic escalating across the country, we sought to evaluate and characterize post-operative opioid prescribing habits and trends among urology residents in the United States.Methods: Urology residents were sent a 16-question survey regarding opioid prescribing patterns, influencing factors, opioid training experience, and amounts of opioids prescribed for common urologic procedures.Results: One hundred and four urology residents participated in the survey (75% male and 25% female). Common factors influencing opioid prescribing were standard prescribing practice for certain operations (80%), attending/senior resident preference (62.1%), and immediate post-operative pain (54.7%). Residents reported prescribing more opioids at discharge for open abdominal and robotic procedures (167.9 and 134.2 morphine milligram equivalents, MME, respectively) and lower amounts for outpatient surgeries (39.7 and 55.8 MME for vasectomy and transurethral resections). Only 15.5% of residents utilize any formal algorithm for post-operative opioid prescribing at their institution. Further, 51.6% of residents received no formal education on safe opioid prescribing during residency, and only 42.1% routinely assess patient risk for opioid abuse. Urology residents who received formal opioid training prescribed less opioids on average for common urologic procedures compared to those who had not trained.Conclusions: This study highlights the importance of increasing resident education on opioid prescribing during residency training, as well as an opportunity for the implementation of standardized post-operative opioid prescribing regimens to help improve trends in urology resident opioid prescribing.

Highlights

With the opioid epidemic escalating across the country, we sought to evaluate and characterize post-operative opioid prescribing habits and trends among urology residents in the United States
Opioid abuse is an epidemic in the United States, with over 19,000 overdose deaths attributed to prescription opioid pain medications reported in 2017 [1]
All post-graduate year (PGY) levels were represented with 16 PGY-1 (15.4%), 23 PGY-2 (22.1%), 19 PGY-3 (18.3%), 24 PGY-4 (23.1%), and 22 PGY-5 or greater (21.2%)

Summary

Introduction

With the opioid epidemic escalating across the country, we sought to evaluate and characterize post-operative opioid prescribing habits and trends among urology residents in the United States. Opioid abuse is an epidemic in the United States, with over 19,000 overdose deaths attributed to prescription opioid pain medications reported in 2017 [1]. Physicians can contribute to this epidemic by regularly utilizing and potentially overprescribing opioid pain medication. In a 2011 study, patients who had undergone urologic surgery reported using 58% of the prescribed opioid pain medication, and 67% had excess opioids from their initial prescription [3]. In a study that reviewed patients who had undergone a major prostate or kidney operation, 60% of opioids prescribed post-operatively went unused, resulting in large amounts of excess oxycodone-equivalents in the community [4]

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