Robot-Assisted Radical Prostatectomy Associated with Decreased Persistent Postoperative Opioid Use

Area of Science:

• Urology
• Oncology
• Pain Management

Background:

• Minimally invasive surgery (MIS) is associated with reduced postoperative pain and opioid consumption.
• Large-scale comparative studies on persistent opioid use after different radical prostatectomy approaches are limited.

Purpose of the Study:

• To assess and compare the incidence of persistent opioid use after open radical prostatectomy versus robot-assisted radical prostatectomy (RARP).

Main Methods:

• Retrospective cohort study using claims data from opioid-naive adult males undergoing radical prostatectomy (July 2013-June 2017).
• Identified new persistent postoperative opioid use (opioid prescription refills 90-180 days after surgery).
• Multivariable logistic regression analyzed the association between surgical approach, patient factors, and persistent opioid use.

Main Results:

• 6.9% of 12,278 patients (1510 open, 10,768 RARP) developed persistent opioid use.
• RARP patients had a 35% lower likelihood of persistent opioid use compared to open surgery patients (6.5% vs 9.7%).
• Independent risk factors included living in specific US regions, preoperative comorbidity, and tobacco use.

Conclusions:

• Persistent opioid use affects approximately 6.9% of opioid-naive patients post-radical prostatectomy.
• Robot-assisted radical prostatectomy is associated with a significantly lower risk of persistent opioid use than open surgery.
• Development of optimized postoperative opioid prescribing protocols for radical prostatectomy patients is warranted.