Predictors and Trends of Opioid-Sparing Radical Prostatectomy From a Large National Cohort

Abstract

To examine the use of pain medications after radical prostatectomy using a large national database. The Premier Hospital Database was queried to identify all robotic and laparoscopic radical prostatectomies from January 2015 to March 2020 with length of stay more than or equal to 1 day. "Opioid-sparing" was defined as absence of intravenous opioid use after post-operative day 0 and absence of oral opioid use throughout admission. Comparisons were made between opioid-sparing and non-opioid-sparing prostatectomy. Logistic multivariable regression was used to identify predictors of opioid-sparing prostatectomy. A total of 62,660 patients were included, of whom 14,806 (23.6%) underwent opioid-sparing prostatectomy. Opioid-sparing prostatectomy was associated with older age (65 vs 63 years, P <.01), white versus black race (76.3% vs 73.4%, P <.01), high-volume surgeons (75.2% vs 70.0%, P <.01), and use of intravenous ketorolac (62.2% vs 48.0%, P <.01), intravenous acetaminophen (32.5% vs 30.1%, P <.01), and liposomal bupivacaine (5.4% vs 4.9%, P <.01). On multivariable regression, ketorolac was the strongest predictor of opioid-sparing prostatectomy (odds ratio: 1.86, 95% confidence interval: 1.79-1.93, P <.01), and black race was predictive of non-opioid sparing prostatectomy (odds ratio: 0.75, 95% confidence interval: 0.71-0.80, P <.01). Ketorolac was not associated with increased risk of postoperative bleeding (0.3% vs 0.3%, P =1.0) or dialysis requirement (<0.1% vs <0.1%, P =.91). Opioid-sparing radical prostatectomy was feasible and associated with administration of each of the non-opioid pain medications assessed. Ketorolac was the strongest predictor of opioid-sparing prostatectomy and was not associated with increased risk of bleeding or dialysis.