Feasibility of a Non-opioid Pathway Post Ureteroscopy: Joint Analysis from Two Academic Center
Mohannad Awad, MD1, Mark Assmus, MD2, Adrian Berg, MD1, Matthew Lee, MD3, Luke Hallgarth, MD1, Amy Krambeck, MD4, Kevan Sternberg, MD1.
1University of Vermont Medical Center, BURLINGTON, VT, USA, 2Indiana University, Indaianapolis, IN, USA, 3Indiana University, Indianapolis, IN, USA, 4Northwestern University, Chicago, IL, USA.
BACKGROUND: In an effort to combat the alarming amount of postoperative opioid prescribing in the United States (U.S.), many surgical specialties are implementing pathways to limit the routine use of postoperative opioids with the goal of zero opioid prescribing. We sought to examine the durability of established non-opioid post ureteroscopy (URS) pathways previously implemented at two academic urology centers in the U.S.
METHODS: We examined patients who underwent URS at two academic centers utilizing a non-opioid postoperative pathway between November 2016 and March 2020. Primary outcomes evaluated included adverse events (Emergency Department (ED) presentation, and Office phone calls for postoperative genitourinary symptoms) for patients discharged with and without opioids. Secondary outcomes were factors associated with adverse events.
RESULTS: In total, 699 patients underwent URS with stent placement. Of these, 652 (89.4%) were discharged without opioids and 74 (10.6%) received opioids postoperatively. Of those discharged without opioids, 484 (77.4%) received non-steroidal anti-inflammatory medications. The majority of patients were prescribed adjunct medications (acetaminophen, phenazopyridine, and/or tamsulosin) upon discharge. Compared to patients discharged without opioids, patients who were prescribed opioids were more likely to present to the ED (67 (10.7%) vs 14 (19.9%), p=0.037) and call the clinic postoperatively for genitourinary symptoms (102 (16.3%) vs 22 (29.7%), p=0.004). In a multivariate analysis, patients prescribed opioids post URS (OR 1.9, 95% CI 1.1 - 3.5, p=0.024) and patients who had an opioid prescription preop (OR 2.2, 95% CI 1.1 - 4.5, p=0.032) were associated with higher odds of calling the clinic for genitourinary symptoms. Older patients (OR 0.98, 95% CI 0.97 - 0.99, p=0.006) were less likely to call the clinic for genitourinary symptoms.
CONCLUSIONS: The study highlights that almost 90% of patients can be discharged safely without opioids following URS. In our cohort, patients prescribed opioids experienced higher postoperative healthcare interactions (ED visits and office phone calls). We hope our results will encourage other urologists to consider non-opioid pathways post URS. 
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