Presented by: Russell E. N. Becker MD, PhD
University of Michigan

Introduction

The outcomes of kidney stone surgery have long been focused on stone-free rates and safety, yet patient reported outcomes (PRO) are often lacking. In 2018 the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) group initiated a pain optimization pathway using an opioid-free multi-modal pain regimen. This has resulted in a decline in opioid prescription rates after ureteroscopy (86 to 19%). We used a comprehensive PRO system to understand the initiative’s impact on patients’ experiences of treatment pain and satisfaction.

Materials

MUSIC ROCKS instituted its patient-reported outcomes (PRO) program in 2020 which included an assessment of patient pain (PROMIS Pain Intensity short form and Pain Interference short form) and overall treatment satisfaction (ICIQ-S). This system is automated and distributes questionnaires preoperatively and at 7-10 days and 4-6 weeks following ureteroscopy (URS). We compared patients who were prescribed opiates after URS to those who were not. After adjusting for observed demographic differences (age, gender, pre-stent status, stone location/size, and preoperative pain), we evaluated PRO pain intensity and interference, with linear mixed models. A clinically meaningful difference in PROMIS scores is 2.5-3.5 points. Treatment satisfaction scores were compared with Wilcoxon rank tests.

Results

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A total of 292 patients completed all questionnaires (258 non-opioid and 34 opioid). There was no significant difference between non-odxzpioid and opioid cohorts with regards to age (60 vs 59 years), gender (50 vs 53% male), pre-stenting status (76 vs 65%), stone location (64 vs 59% ureteral), and stone size (8.0 vs 7.2 mm). After adjustment, there was no significant difference in preoperative pain intensity scores between the groups at pre-URS (p=0.06), 7-10 days postop (p=0.87), and 4-6 weeks postop (p=0.99, Figure). Pain interference followed a similar pattern, with no significant differences observed at any timepoint. There was no difference in satisfaction scores, as measured both 7-10 days (p = 0.46) and 4-6 weeks (p =0.47) after URS.

Conclusion

Rates of opiate prescription have declined after ureteroscopy in Michigan. Using a novel PRO system, we confirmed that URS of opioid-free pathways has not resulted in increased pain nor decreased patient satisfaction.

Funding

Blue Cross Blue Shield of Michigan

Lead Authors

Andrew M. Higgins, MD, MS
University of Michigan

Co-Authors

Stephanie Daignault-Newton, MS
University of Michigan

Golena Fernandez Moncaleano, MD
University of Michigan

John K. Ludlow, MD
Western Michigan Urological Associates/Holland Hospital

Hector Pimentel, MD
Corewell Health

Brian D. Seifman, MD
Michigan Institute of Urology

David L. Wenzler, MD
Michigan State University College of Human Medicine

Bronson Conrado, MHSA
University of Michigan

Karla Witzke, DO
MyMichigan Health

Khurshid R. Ghani, MBChB, MS, FRCS
University of Michigan

Casey A. Dauw, MD
University of Michigan