Presented by: Richard Berman BA
Columbia University Vagelos College of Physicians & Surgeons

Introduction

Kidney stones commonly result in emergency department (ED) visits due to high levels of associated pain. Opioids are frequently prescribed due to their potency and rapid onset; however, overuse of opioids can lead to dependence and abuse. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also effective in managing renal colic with a different risk profile. This study aims to examine recent national trends in opioid and NSAID use for ED encounters related to kidney stones in the United States (US).

Materials

Kidney stone ED encounters were identified within National Hospital Ambulatory Medical Care Survey data from 2015 to 2020. National estimates were derived from a multistage survey weighting procedure to account for selection probability, nonresponse, and population weights. Trends in medication use were estimated from logistic regression on the year of the encounter, adjusting for selected demographic and clinical characteristics. Results were considered statistically significant with two-sided p-values < 0.01.

Results

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There were an estimated 8,033,609 ED encounters for kidney stones in the US from 2015 to 2020. The mean age was 47 (± 17) years, 54% of patients were male, and 75% were White. Overall, 5,481,326 (68%) patients received opioids and 5,199,967 (65%) patients received NSAIDs. Opioid use decreased significantly during the study period (annual odds ratio [OR]: 0.84, 99% confidence interval [CI] 0.71-0.99, p = 0.006), and there was no significant change in NSAID use (annual OR: 1.09, 99% CI 0.91-1.30, p = 0.214) (Figure). There was regional variation in opioid use, with opioid use more common in the West than in the Northeast (OR: 3.15, 99% CI 1.15-8.62, p = 0.004). 4,198,607 (52%) patients received opioids during their ED visit, and 3,498,702 (48%) patients were prescribed opioids at discharge. Overall, 37% of patients were given opioids that were stronger than morphine, including oxycodone (20%), hydromorphone (19%), and fentanyl (4%).

Conclusion

Although opioids are still frequently used to manage renal colic in the ED, opioid use has decreased in recent years. These results may suggest improved national opioid stewardship from ED physicians in response to the opioid epidemic. Ongoing high rates of opioid use underscore opportunities for continued efforts.

Funding

None

Co-Authors

Juliana Villanueva, MD, MPH
Columbia University Mailman School of Public Health

Ezra Margolin, MD
Columbia University Department of Urology

Ojas Shah, MD
Columbia University Department of Urology