Institutional Opioid Prescription Guidelines are Effective in Reducing Post-Operative Prescriptions Following Urologic Surgery: Results From the American Urologic Association 2018 Census

• Published in: Urology (Ridgewood, N.J.) N.J.), 2021-12, Vol.158, p.5-10
• Main Authors: Amend, Gregory M., Hakam, Nizar, Nabavizadeh, Behnam, Sadighian, Michael J., Holler, Jordan T., Rios, Natalie, Li, Kevin D., Low, Patrick, Awad, Mohannad A., Davies, Benjamin J., Breyer, Benjamin N.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; Censuses; Drug Prescriptions - statistics & numerical data; Humans; Pain, Postoperative - drug therapy; Practice Guidelines as Topic; Societies, Medical; United States; Urologic Surgical Procedures; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2021.08.033

To assess provider and practice characteristics that drive opioid prescription behavior using the American Urological Association census data. Stratified weighted analysis using 1,157 census samples was performed to represent 12,660 urologists who practiced in the United States in 2018. We compared urologists according to their opioid prescription patterns to evaluate factors and motivations behind opioid use in the post-operative setting. Overall, 11,205 (88.5%) urologists prescribe opioids in the post-operative setting. The presence of procedure-specific institutional prescribing guidelines was associated with a greater tendency to prescribe ≤10 pills, and lesser tendency to prescribe 11 to 49 and ≥50 tablets following open abdominal (P = .003), laparoscopic (P < .001), scrotal (P < .001), and endoscopic surgeries (P < .001). The presence of institutional prescribing guidelines was associated with decreasing opioid prescriptions over a three-year period whereas not having guidelines was associated with an unchanged prescription practice over time. Basing current prescriptions on what was given to prior patients was reported by 85% and was more likely to result in an unchanged amount of prescriptions over time (29.2% vs 13.3%, P = .007). Motivations to avoid patient phone calls were reported by 23.8% and were more likely to increase the opioids provided within the next 3 years (3.2% vs 0.1%, P < .001). Practitioners who endorsed using institutional guidelines prescribed fewer opioids following all types of surgery and were more likely to decrease their prescription behavior over time. This data supports continued efforts to provide urologists with more evidence-based guidance on best practice opioid prescribing in the future.