Introduction: Efforts to control post-operative opioid prescriptions (opioid-Rx) given after major urologic surgery have yielded mixed results. Since, even a transient exposure to opioids can increase the risk of opioid abuse, the goal should be to prescribe the fewest number of opioids without compromising pain control. We designed a prospective intervention study, No Opioids Prescriptions at Discharge After Surgery (NOPIODS study) to test the feasibility of eliminating opioid-Rx at discharge following major urologic surgery.
Methods: This study included 686 consecutive patients, who underwent open or robotic, prostatectomy, radical or partial nephrectomy and radical cystectomy from May 2017 to June 2021. The pre-intervention, control group, included patients receiving opioid-Rx at discharge at the prescriber’s discretion (N= 202). We implemented the opioid-Rx elimination protocol in 2 phases, 1. Lead-in phase (N= 100): prescriber instructions to minimize opioid-Rx to = 4 days, based on pain assessment at discharge; 2. NOPIOIDS phase (N=384): policy of no opioid-Rx unless necessary per patients’ requirements. Patients in both phases received education on expected levels of pain and multimodal analgesia protocol. Patient satisfaction was assessed through surrogates including phone calls for pain and requirement for additional opioid-Rx within 30 days of discharge as confirmed by I-STOP (Prescription monitoring program). Categorical and continuous variables were compared using Chi-square and one-way ANOVA, as applicable.
Results: The proportion of patients discharged without any opioid-Rx in the control, lead-in and NOPIOIDS group was 19.1%, 42.1% and 97.8%, respectively. All patients receiving opioid-Rx in the NOPIODS group had renal surgery (partial or radical nephrectomy). The median (IQR) number of 5mg-oxycodone equivalents prescribed per patient was 14 (10-20), 4 (0-5.3), and 0 (0-0), in control, lead-in, and NOPIOIDS group, respectively (p <0.001). Phone calls related to inadequate pain control were similar amongst the control, lead-in, and NOPIOIDS group at 4.1%, 2.1% and 3.1% (p = 0.64), respectively. Patients requiring additional opioid-Rx within 30 days of discharge, were similar amongst the control, lead-in and NOPIOIDS group at 4.1%, 0% and 2.2% (p=0.10), respectively.
Conclusions: This study highlights the feasibility of eliminating opioid-Rx after major urologic surgery without compromising analgesia. This intervention is easy to implement, does not require additional resources, and should be the new standard of care following major urologic surgery.
.jpg)
.jpg)
