Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis.

Document Type

Article

Publication Date

1-2024

Publication Title

Urology practice

Abstract

INTRODUCTION: Opioid prescription following surgery has played a role in the current opioid epidemic. We evaluated practice-level variation in opioid prescribing following surgery for cT1 renal masses and examined the relationships between opioid-free discharge and postoperative emergency department visits (ED) and readmissions.

METHODS: We retrospectively examined all T1 renal mass (RM) patients with data regarding postoperative opioid prescriptions within the MUSIC-KIDNEY registry from April 2021 to March 2023. Patients were stratified into those who received opioids at discharge and those with opioid-free discharge. Associations with patient, tumor, and surgical factors were evaluated. Rates of postoperative ED visits and readmissions within 30 days were compared between cohorts. Practice-level variation was assessed.

RESULTS: Of 414 patients who underwent surgery for T1RM across 15 practices in MUSIC-KIDNEY, 23.7% had opioid-free discharge. Practice level variation in rates of opioid-free discharge ranged from 6.7% to 55.0%. For patients prescribed opioids, the median number of pills was 10 (IQR 6-12). Patients with cT1b masses were more likely to have opioid-free discharge (44.9% vs 32%, OR 0.44; 95% CI 0.22-0.89). Rates of 30-day ED visits (7.0% vs 3.1%) and readmissions (4.1% vs 2.0%) were lower in the opioid-free discharge group but did not reach statistical significance.

CONCLUSION: MUSIC-KIDNEY data suggests opioid-free discharge is not associated with increased rates of postoperative ED visits or readmissions. There exists wide practice-level variation in opioid prescriptions following surgery for T1RM in the state of Michigan. Similar variation likely exists throughout the United States, and best surgical practice suggests reduction in opioid prescribing after nephrectomy.

Volume

11

Issue

1

First Page

126

Last Page

132

DOI

10.1097/UPJ.0000000000000478

ISSN

2352-0787

PubMed ID

37987620

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