Presented by: Emily Serrell MD
University of Wisconsin

Introduction

In opioid naïve patients, experts recommend prescribing 0-10 opioid doses following common kidney stone procedures. It is unclear to what extent patients are exposed to narcotics preoperatively. We aim to quantify pre- and post-operative opioid prescribing patterns in patients undergoing ureteroscopy (URS) and shock wave lithotripsy (SWL) and measure the association between pre-operative opioid exposure and post-operative prescribing.   

Materials

We used the Wisconsin Health Information Organization database, which captures over 75% of Wisconsin’s population. We collected demographic data on adult patients undergoing URS and SWL between 1/1/2017 and 12/31/2021. We evaluated pre- and post-operative opioid prescriptions, quantified opioid exposure in morphine milligram equivalents (MME), and compared prescribing characteristics between opioid naïve and opioid exposed patients (defined as those with a filled prescription in 6 months before surgery).

Results

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We identified 14,075 patients (10,886 URS, 3,189 SWL). Overall, 45% of patients filled a pre-operative prescription with similar proportion for the URS (45%) and SWL (45%) patients.  The majority of fills occurred in the 3 weeks prior to surgery (63%; Figure) at a median time of 16 days (IQR 8-40) with 18% fills occurring >8 weeks prior. Patients filled 1 prescription (IQR 1-3) with a median dose of 150 MME (IQR 90-337). Post-operatively, 50% of patients filled a prescription with a median first fill dose of 120 MME (IQR 75-210), equivalent to sixteen 5mg oxycodone tablets. Opioid exposed patients had a significantly higher 2 week post-operative dose (171 vs 131 MME, p<0.001) and number of prescriptions (1.43 vs 1.35, p<0.001).  

Conclusion

Nearly half of patients undergoing kidney stone procedures are not opioid naïve, with the majority filling prescriptions in the three weeks before surgery. After surgery, more than half of patients filled an opioid prescription. For all patients, pre- and post-operative prescribing remains significantly higher than recommended. Patients with prior opioid exposure had significantly higher number and dosage of opioid prescriptions.  Incorporating opioid exposed patients into guideline recommendations is imperative to inform real world care.  

Funding

None

Lead Authors

Tudor Borza, MD
University of Wisconsin

Jessica Schumacher,
University of Wisconsin

Manasa Venkatesh,
University of Wisconsin

Randi Cartmill,
University of Wisconsin

Robert Tyllo,
University of Wisconsin

Margaret Knoedler,
University of Wisconsin

Stephen Nakada,
University of Wisconsin