#1197

Evidence-Based Opioid Prescribing and Patient-Reported Pain Outcomes after Percutaneous Nephrolithotomy

K. Koo¹, G. Ungerer¹, R. Qi¹, C. Liaw¹, A. Potretzke¹

¹Mayo Clinic, Rochester, United States

Introduction:

Patients recovering from percutaneous nephrolithotomy (PCNL) may experience multiple sources of pain. To encourage opioid stewardship, patients’ in-hospital opioid use may help determine post-discharge prescribing needs. We aimed to characterize patient-reported pain outcomes based on a PCNL opioid prescribing algorithm.

Material and methods:

A prospective cohort of adult patients undergoing standard (24–30 Fr) PCNL were enrolled. Patients were discharged with ureteral stents for 1 week. Patients received multimodal analgesics, including acetaminophen, NSAIDs, tamulosin, and anticholinergics. We followed an evidence-based opioid prescribing algorithm based on inpatient opioid use in the 24 hours prior to discharge: patients who used 0 morphine milligram equivalents (MME) were prescribed no opioids; patients who used ≤25 MME were prescribed up to 37.5 MME (5 tablets oxycodone 5 mg); and patients who used >25 MME were prescribed up to 75 MME (10 tablets oxycodone 5 mg). Patients reported pain scores, opioid use, and symptoms on day 3, 7, and 14 after discharge. Patients were surveyed at 4 weeks about total medication use and opioid disposition.

Results:

A total of 75 patients were enrolled. Most patients reported mild pain during post-discharge recovery that resolved within 1 week: median pain scores were 3 (IQR 1–4) at day 3, 1 (IQR 0–2) at day 7, and 0 (IQR 0–2) at day 14 (Figure). The most bothersome symptom during recovery was bladder spasm (31%), flank pain (28%), and incision pain (15%). Using the algorithm, 32% of patients were prescribed opioids at discharge. Among the opioid group, 83% reported taking at least 1 dose. There were no significant differences in pain scores based on whether opioids were prescribed. No patients required a new or refill opioid prescription after discharge. At 4 weeks after surgery, 78% of patients who were prescribed opioids still had unused opioids, with a median of 50% of the total prescribed MME remaining (IQR 40–60%). Only 6% of patients had disposed of unused opioids.