MP44-01 LARGE VARIATION AND LARGE DOSES: OPIOID PRESCRIBING PATTERNS IN A NATIONAL VA COHORT

Abstract

INTRODUCTION AND OBJECTIVES: There is known substantial variation in non-surgical opioid prescribing but there is limited data characterizing opioid use in the postoperative period, though recommendations exist to limit postoperative narcotic prescriptions to 7 days, or 200mg oral morphine equivalents (OME). We sought to evaluate variation of postoperative opioid prescribing after inpatient urologic surgery in a national VA population, hypothesizing that we would identify considerable variation in opioid prescribing behavior following common major urologic surgery. METHOD(S): Using the VA Corporate Data Warehouse (CDW), we retrospectively identified all patients who underwent open or minimally invasive (MIS) nephrectomy, prostatectomy, cystectomy, transurethral resection or photovaporization of the prostate from 1/1/2014 - 12/31/2016 at a VA Medical Center. We obtained demographic, operative, and discharge opioid prescription (Rx) data for each case. We used chisquared tests, quantile regression and a multivariable logistic regression model to characterize the relationship between a priori identified covariates with prescribed OME. RESULT(S): We identified 19,823 patients who underwent one of the candidate procedures from 2014-2016. The average age was 67 years and procedures were evenly divided by geographic region and year. Across all procedures there was a very large range of prescribed postoperative opioid dose, from 0 to 7560mg OME, with a median of 225mg OME excluding TURP/PVP (Figure 1). We did not observe any difference in prescribed postoperative OME between open and MIS procedures. Those in the highest quartile of OME dose were more likely to be younger, have slightly increased LOS, have undergone surgery in a teaching facility or in the South, or have filled an opioid Rx within 90 days before surgery. However, pre-operative opioid use only explained 5% of observed variance. CONCLUSION(S): These data reveal very high post-operative opioid Rx doses and substantial variation after common inpatient urologic surgeries. The vast majority exceed current opioid prescribing recommendations and remain high even for populations expected to have significantly lower pain requirements including MIS and opioid-naive patients. These data identify a significant opportunity for improvement in postoperative opioid prescribing. (Figure Presented).