Post-Operative Opioid Prescribing Practices and Trends Among Urology Residents in the United States

Abstract

Introduction: With the opioid epidemic escalating across the country, we sought to evaluate and characterize post-operative opioid prescribing habits and trends among urology residents in the United States.Methods: Urology residents were sent a 16-question survey regarding opioid prescribing patterns, influencing factors, opioid training experience, and amounts of opioids prescribed for common urologic procedures.Results: One hundred and four urology residents participated in the survey (75% male and 25% female). Common factors influencing opioid prescribing were standard prescribing practice for certain operations (80%), attending/senior resident preference (62.1%), and immediate post-operative pain (54.7%). Residents reported prescribing more opioids at discharge for open abdominal and robotic procedures (167.9 and 134.2 morphine milligram equivalents, MME, respectively) and lower amounts for outpatient surgeries (39.7 and 55.8 MME for vasectomy and transurethral resections). Only 15.5% of residents utilize any formal algorithm for post-operative opioid prescribing at their institution. Further, 51.6% of residents received no formal education on safe opioid prescribing during residency, and only 42.1% routinely assess patient risk for opioid abuse. Urology residents who received formal opioid training prescribed less opioids on average for common urologic procedures compared to those who had not trained.Conclusions: This study highlights the importance of increasing resident education on opioid prescribing during residency training, as well as an opportunity for the implementation of standardized post-operative opioid prescribing regimens to help improve trends in urology resident opioid prescribing.

Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better?

“…A mere estimation of 48.4% of residents obtained formal training on appropriate opioid prescribing in their residency training and just 42.1% of residents analyze for opioid abuse in their patients. 6 These stats reiterate the importance of establishing stronger and more comprehensive safe practice guidelines for the administering of opioids specifically post-operatively. 6 Additionally, one study noted that only 16% of providers figured their patients will finish all of the opioids prescribed and another result noting 67% of pediatric urology patients had extra opioids leftover in the post-operative period.…”

“…6 These stats reiterate the importance of establishing stronger and more comprehensive safe practice guidelines for the administering of opioids specifically post-operatively. 6 Additionally, one study noted that only 16% of providers figured their patients will finish all of the opioids prescribed and another result noting 67% of pediatric urology patients had extra opioids leftover in the post-operative period. 9,10 Building upon the concept of improved education and awareness regarding the safe prescribing and use of opioids, we did witness effective change in our analysis when goals and open discussion among healthcare professionals took place.…”

“…5 To better address the misuse of opioids specifically in urology, it might be beneficial to develop and utilize a standardized post-operative opioid prescribing protocol. 6 In a study analyzing urology resident opioid prescribing habits, it was noted that only 15.5% of residents use a structured algorithm in prescribing opioids post-operatively. Additionally, not even half of residents (51.6%) had formal training on how to appropriately prescribe opioids with 42.1% of residents regularly examining for opioid abuse in their patients.…”

“…Additionally, not even half of residents (51.6%) had formal training on how to appropriately prescribe opioids with 42.1% of residents regularly examining for opioid abuse in their patients. 6 In a similar study assessing opioid prescribing habits in residents of different specialties including urology it was noted that just 35% of residents noted they had formal training regarding appropriate opioid prescribing. 7 The study also found that residents did not use standardized order sets at a high rate and that patient education and expectations with opioid prescription were not met well.…”