Opioid use after uro-oncologic surgeries in time of opioid crisis

• Published in: Canadian Urological Association journal 2022-08, Vol.16 (8), p.e432-E436
• Main Authors: Turcotte, Bruno, Jacques, Emma, Tremblay, Samuel, Toren, Paul, Caumartin, Yves, Lodde, Michele
• Format: Article
• Language: English
• Subjects: Care and treatment; Dosage and administration; Drug therapy; Opioids; Original Research; Pain, Postoperative; Risk factors; Surgery; Surveys; Urinary organs; Urinary tract cancer
• ISSN: 1911-6470; 1920-1214
• DOI: 10.5489/cuaj.7633

Introduction: Recent literature emphasizes how overprescription and lack of guidelines contribute to wide variation in opioid prescribing practices and opioid-related harms. We conducted a prospective, observational study to evaluate opioid prescriptions among uro-oncologic patients discharged following elective inpatient surgery. Methods: Patients who underwent four surgeries were included: open retropubic radical prostatectomy, robot-assisted radical prostatectomy, laparoscopic radical nephrectomy, and laparoscopic partial nephrectomy. The primary outcome was the dose of opioids used after discharge (in oral morphine equivalents [MEq]). Secondary outcomes included: opioid requirements for 80% of the patients, management of unused opioids, opioid use three months postoperative, opioid prescription refills, and guidance about opioid disposal. Results: Sixty patients were included for analysis. Patients used a mean of 30 MEq (95% confidence interval 17.8-42.2) at home and 80% of the patients used 50 MEq or less. A mean of 40.4 MEq per patient was overprescribed. Fifty percent of the patients kept the remaining opioids at home, with only 20.0% returning them to their pharmacy. After three months, 5.0% of the patients were using opioids at least occasionally. Three patients needed a new opioid prescription. Forty percent reported having received information regarding management of unused opioids. Conclusions: We found 60% of opioids prescribed were unused, with half of our patients keeping these unused tablets at home. Our results suggest appropriate opioid prescription amounts needed for urological cancer surgery, with 80% of the patients using 50 MEq or less of morphine equivalents.