Faculty of Medicine and Dentistry
University of Alberta
Analgesic use after endourologic surgery: A provincial analysis of 13,000 patients
Vardhil Gandhi1, Runhan Ren2, Zoe Hsu3, Erik Youngson3, Shubhadip (Shubha) K. De2.
1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; 2Division of Urology , University of Alberta , Edmonton , AB, Canada; 3NACTRC, University of Alberta, Edmonton, AB, Canada
Endourology procedures are typically categorized as minor surgery, and post-operative analgesic requirements are considered minimal. As several studies have recently shown narcotic prescribing patterns after minor surgery may put patients at risk of dependence, we sought to assess our local patient population. The objective of this study is to assess the use of post operative analgesia, and long term implications of these practice patterns in patients undergoing endourology procedures.
A retrospective cohort was created, through the provincial Data Integration, Management and Reporting (DIMR) unit (April 2013-18). Patients were identified using claims data for a stent insertion ± endoscopic procedure. Pharmaceutical Information Network (PIN) data 1y pre and post intervention were collected. Descriptive statistics were used to present demographics, prescribing patterns, and health care utilization.
13,820 SI patients were identified in Alberta over 5y. Average dwell time was 45d, 78% had one SI, and 63% underwent simultaneous endoscopy (53% fURS, 5.5% PCNL, 0.2% SWL, 2.6% semi-rigid URS). 84% were placed as day surgery/ambulatory setting. 6% had an unplanned visit within 48hr. In the year preceding SI, 28% had one or more prescriptions for oral analgesia (72% narcotics, 28% NSAIDs). An additional 5.5% received a prescription 1-7days prior to their index stent. After SI, 4.3% filled an analgesic prescriptions within 1 day, and 9.6% within the first week. Of those patients who were dispensed analgesia on the day of SI, 71% received NSAIDS, and 20% Tramacet. Overall a 5.3% (n=743) increase in dispensed narcotics was observed in the year following SI (excluding the post operative period).
Preliminary analyses of a provincial cohort show that even with a reliance on NSAIDs after endourology procedures, there is still a large exposure to rescue narcotics. Here we suggest a 5.3% increased rate of long term opiate use after endourology procedures in Alberta.
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|Endourology||Analgesic use after endourologic surgery: A provincial analysis of 13,000 patients||TBD|