Patterns of Opioid Prescription Post Ureteroscopy Among Members of the Endourological Society
Mohannad A. Awad, MD1, David W. Sobel, MD2, Ben H. Chew, MD3, Benjamin N. Breyer, MD4, Mark K. Plante, MD1, Kevan M. Sternberg, MD1.
1University of Vermont Medical Center, Burlington, VT, 2The Minimally Invasive Urology Institute at the Mariam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, 3University of British Columbia, Vancouver, BC, Canada, 4University of California - San Francisco, San Francisco, CA.
Introduction: Post-operative opioid prescription has been linked with persistent opioid use. Ureteroscopy (URS) is one of the most common urologic procedures, and therefore a potential area of focus to limit opioid prescribing among urologists. The aims of this study are to characterize national and international practice patterns of opioid prescription post URS and define reasons for opioid use in this setting.
Methods: We developed a survey directed to members of the Endourological Society. The survey was composed of 12-16 questions targeting practice patterns, frequency of opioid prescription post ureteroscopy, challenges faced when opioids are not prescribed and specific measures thought to be helpful to reduce the need for opioid prescriptions. The final survey was electronically distributed to 2000 Endourological Society members listed in the 2018-2019 Membership Directory. Accrual period was during May 2019.
Results: With a response rate of 8% (159/2000), the majority of respondents reported practicing urology for >20 years (37.1%), and performing 10-20 ureteroscopies/month (45.3%). Around 40% of respondents were from the United States (US) and Canada. 66% completed a fellowship, 84% of which were endourology. 26% report routinely prescribing opioids and the majority do so less than 10% of the time (62.3%). 38% had no challenges when opioids were omitted. Measures felt to decrease the need for opioids were preoperative counseling, nonsteroidal anti-inflammatory drugs use, and use of adjunct medications. After adjusting for location, practice type, endourology fellowship completion, years of practice, and number of ureteroscopies/month, we found that respondents from the US and Canada were more likely to prescribe opioids routinely post URS, (Odds Ratio 87.5, P<0.001, 95% Confidence Interval 17.3-443.5).
Conclusions: Among participants in our survey, nearly one quarter of urologists prescribe opioids routinely post URS, and US and Canadian urologists were more likely to prescribe routinely compared to the rest of the world. Despite proven feasibility of non-opioid management following URS, many urologists continue to prescribe opioids in this setting. We believe best practice guidelines by the American and Canadian Urological Associations should be considered to reduce opioid prescribing post ureteroscopy. 
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