Abstract
Introduction: Minimally invasive surgery offers reduced pain and opioid use postoperatively compared with open surgery, but large-scale comparative studies are lacking. We assessed the incidence of persistent opioid use after open and robot-assisted radical prostatectomy (RARP).Materials and Methods: We performed a retrospective claims database cohort study of opioid-naive (i.e., no opioid prescriptions 30–180 days before index surgery) adult males who underwent radical prostatectomy for prostate cancer from July 2013 to June 2017. For patients who filled a perioperative opioid prescription (30 days before to 14 days after surgery), we calculated the incidence of new persistent postoperative opioid use (≥1 prescription 90–180 days after surgery). Multivariable logistic regression was performed to investigate the association between the surgical approach, patient risk factors, and persistent opioid use.Results: Twelve thousand two hundred seventy-eight radical prostatectomy patients filled an opioid prescription perioperatively (1510 [12%] open and 10,768 [88%] robot assisted). Of these, 846 (6.9%) patients continued to fill opioid prescription(s) 90 to 180 days after surgery. Patients undergoing RARP were 35% less likely to develop new persistent opioid use compared with those undergoing open radical prostatectomy (6.5% vs 9.7%; adjusted odds ratio 0.65; 95% confidence interval 0.54, 0.79). Other independent risk factors included living in the southern, western, or north central United States; preoperative comorbidity; and tobacco use.Conclusions: Approximately 6.9% of opioid-naive patients continued to fill opioid prescriptions 90 days after radical prostatectomy. The risk of persistent opioid use was significantly lower among patients undergoing a robot-assisted vs open approach. Further efforts are needed to develop postoperative opioid prescription protocols for patients undergoing radical prostatectomy.
Highlights
Invasive surgery offers reduced pain and opioid use postoperatively compared with open surgery, but large-scale comparative studies are lacking
The final cohort consisted of 12,278 patients: 1510 (12.3%) underwent open radical prostatectomies (ORPs) and 10,768 (87.7%) underwent robot-assisted radical prostatectomy (RARP) (Fig. 2)
Patients who underwent ORP were older, had more comorbidities, and a greater proportion lived in the southern region of the United States compared with those who underwent RARP
Summary
Invasive surgery offers reduced pain and opioid use postoperatively compared with open surgery, but large-scale comparative studies are lacking. Over the past two decades, the United States has seen a sharp rise in opioid medication prescriptions This rise has coincided with an increase in drug overdoses, with prescription opioids accounting for more than 17,000 overdose deaths in 2017.1 Opioids have long played a critical role in pain management among surgical patients, and for many patients, surgery may be their first opioid exposure.[2] Among previously opioid-naıve patients, *6% continue to use opioids more than 3 months after surgical procedures.[3] In one study, over 80% of patients undergoing low-risk surgery received a prescription for opioid medications, and those who were prescribed perioperative opioids were 44% more likely to receive opioids 1 year postoperatively compared with those who did not receive a perioperative prescription.[4,5]. Understanding the factors that place patients at higher risk for persistent or prolonged opioid use is critical to minimizing opioid dependence after surgery.[5]
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