Wang Yuzhi, Wilder Samantha, Van Til Monica, Qi Ji, Mirza Mahin, Gadzinski Adam, Maatman Thomas, Lane Brian R, Rogers Craig G
Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan.
Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
Urol Pract. 2024 Jan;11(1):126-132. doi: 10.1097/UPJ.0000000000000478. Epub 2023 Nov 21.
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 (ED) visits and readmissions.
We retrospectively examined all T1 renal mass (RM) patients with data regarding postoperative opioid prescriptions within the Michigan Urological Surgery Improvement Collaborative-Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy (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.
Of 414 patients who underwent surgery for T1 RM 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.
MUSIC-KIDNEY data suggest 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 T1 RM in the state of Michigan. Similar variation likely exists throughout the United States, and best surgical practice suggests reduction in opioid prescribing after nephrectomy.
手术后的阿片类药物处方在当前的阿片类药物流行中起到了一定作用。我们评估了cT1期肾肿块手术后阿片类药物处方在实践层面的差异，并研究了无阿片类药物出院与术后急诊科就诊和再入院之间的关系。
我们回顾性研究了密歇根泌尿外科手术改进协作组-肾肿块：确定和定义必要评估与治疗（MUSIC-KIDNEY）登记处2021年4月至2023年3月期间所有有术后阿片类药物处方数据的T1期肾肿块（RM）患者。患者被分为出院时接受阿片类药物的患者和无阿片类药物出院的患者。评估了与患者、肿瘤和手术因素的关联。比较了两组队列术后30天内急诊科就诊和再入院的发生率。评估了实践层面的差异。
在MUSIC-KIDNEY的15个医疗机构中接受T1期RM手术的414例患者中，23.7%为无阿片类药物出院。无阿片类药物出院率在实践层面的差异范围为6.7%至55.0%。对于开具阿片类药物的患者，药丸中位数为10（四分位间距6-12）。cT1b期肿块患者更有可能无阿片类药物出院（44.9%对32%，比值比0.44；95%置信区间0.22-0.89）。无阿片类药物出院组的30天急诊科就诊率（7.0%对3.1%）和再入院率（4.1%对2.0%）较低，但未达到统计学显著性。
MUSIC-KIDNEY数据表明，无阿片类药物出院与术后急诊科就诊率或再入院率增加无关。密歇根州T1期RM手术后的阿片类药物处方在实践层面存在很大差异。美国各地可能也存在类似差异，最佳手术实践建议肾切除术后减少阿片类药物处方。
