Opioid Use After Nephrectomy for Kidney Cancer in Ontario: A Population-Based Study.

Area of Science:

• Urology
• Oncology
• Pain Management
• Health Services Research

Background:

• Minimally invasive surgery (MIS) is increasingly used for nephrectomy.
• Understanding post-operative opioid use is crucial for pain management and opioid stewardship.
• Differences in opioid use between MIS and open nephrectomy require investigation.

Purpose of the Study:

• To compare the odds of early and prolonged post-operative opioid use in patients undergoing minimally invasive surgery (MIS) versus open surgery for nephrectomy.
• To identify predictors of opioid use after nephrectomy.

Main Methods:

• Population-level retrospective cohort study of opioid-naïve patients undergoing nephrectomy for kidney cancer in Ontario (1994-2017).
• Opioid use determined via prescription databases (Ontario Drug Benefit, Narcotics Monitoring System).
• Multivariable generalized estimating equation logistic regression used to assess predictors, accounting for surgeon clustering.

Main Results:

• 67.4% of patients received early post-operative opioid prescriptions.
• Open nephrectomy was associated with higher odds of early opioid use compared to MIS (OR 1.36, 95% CI 1.19-1.55).
• Prolonged opioid use was low (1.6-4.4%) and not significantly associated with surgery type.

Conclusions:

• Patients undergoing open nephrectomy have increased odds of early post-operative opioid use compared to MIS.
• Prolonged opioid use after nephrectomy is infrequent and not significantly influenced by surgical approach.
• Findings support careful opioid prescribing practices, particularly after open nephrectomy.