Clinical Assistant Professor University of Calgary
Introduction: Due to the public health crisis of opioid misuse in North America, several recent studies have examined the use of minimal or opioid free prescriptions following various surgeries in opioid naïve patients (ONPs). In May 2021, we started a quality improvement project for elective and emergency ureteroscopy (URS) for nephrolithiasis with opioid free standardized prescriptions consisting only of Ketorolac, Acetaminophen, Solifenacin, Ciprofloxacin, and Tamsulosin to be used by the adult Urology group at their discretion. Methods: The control cohort consisted of ONPs who underwent URS in the 12 months prior to initiation of intervention while the opioid free cohort consisted of ONPs who underwent URS in the 12 months after initiation of intervention. Our main outcome was the average morphine milligram equivalents (MME) of prescriptions filled for pain control within 3 days of hospital discharge. Our balancing measures included readmission within 90 days and outpatient MME prescriptions filled between 3- and 90-days post discharge. Measures were compared across pre- and post-intervention groups using control charts and traditional hypothesis testing. Results: In the current study, 3256 patients were retrospectively reviewed; the opioid free cohort consisted of 1373 ONPs and the control cohort consisted of 1883 ONPs. The average age was 53 with 60% males. Majority of stones were >4mm and majority of patients had multiple stones. There was a significant reduction in MME prescriptions filled in the opioid free cohort compared to the control (19.7 vs. 41.2, p<0.001) (Fig 1). System stability was maintained post intervention along with no significant increase in readmission rates in the experimental cohort (Fig 2). Conclusions: Using a simple standardized prescription intervention following URS in large series of over 3000 patients, there was a significant reduction of 50% in opioids prescribed at discharge with no significant increase in outpatient prescriptions or readmissions. This intervention provides evidence for opioid free discharges in ONPs undergoing URS. SOURCE OF Funding: None.
