A Prospective Cohort Study of Postdischarge Opioid Practices After Radical Prostatectomy: The ORIOLES Initiative

Hiten D. Patel, Arnav Srivastava, Neil D. Patel, Farzana A. Faisal, Wesley Ludwig, Gregory A. Joice, Zeyad R. Schwen, Mohamad E Allaf, Misop Han, Amin Herati

Research output: Contribution to journalArticlepeer-review

Abstract

Opioid pain medications are overprescribed, but few data are available to help in appropriate tailoring of postdischarge opioid prescriptions after surgery. Prior studies are retrospective and based on incomplete responses (<50%) to questionnaires, with small sample sizes for any particular surgery. The ORIOLES initiative was a prospective cohort study (2017–2018) designed to measure postdischarge opioid prescribing and use and clinical predictors of use for consecutive patients after radical prostatectomy. The objectives were to establish a postdischarge opioid reference value to meet the needs of >80% of patients and compare open and robotic surgery. A total of 205 adult patients were enrolled, with 100% completing follow-up. In units of oral morphine equivalents (OMEQ), a median of 225 mg was prescribed and 22.5 mg used. There was no difference by surgical approach or among patients with a history of pain-related diagnoses. Overall, 77% of postdischarge opioid medication was unused, with 84% of patients requiring ≤112.5 mg OMEQ. Only 9% of patients appropriately disposed of leftover medication. Approximately 5% reported continued incisional pain due to surgery at 30 d, but none required continued opioid medication use. Prescribing more opioids was independently associated with greater opioid use in adjusted models. Patient summary: In this report, we looked at opioid medication use following discharge after radical prostatectomy. We found that 77% of opioid pain medication prescribed was unused, with 84% of patients using less than half of their prescription. Prescribing more opioids was associated with greater use; only 9% of patients appropriately disposed of leftover medication. In the ORIOLES study, 77% of opioid pain medication prescribed after radical prostatectomy was unused, with 84% of patients using less than half their prescription. Prescribing more opioids was associated with greater use; only 9% of patients appropriately disposed of leftover medication.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Opioid analgesics
  • Postoperative pain
  • Prostate cancer
  • Radical prostatectomy
  • Surgery
  • Surgical recovery

ASJC Scopus subject areas

  • Urology

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