Persistent Opioid Use Following Artificial Urinary Sphincter Placement: A Large Claims Database Analysis

To assess risk of persistent opioid use and emergency department (ED) and office/outpatient visits following post-operative prescriptions of common opioids in patients following artificial urinary sphincter (AUS) implantation using a nationwide claims database.

The TriNetX US Collaborative Network, which encompasses over 115 million patients from 66 healthcare organizations was used to identify males who underwent first-time AUS placement between 2010-2024. Patients with history of opioid dependence/abuse, opioid use within 6 months prior to AUS placement, or surgery within 9 months post-operation were excluded. Patients were distributed into 2 cohorts: those who received opioids post-operatively or those that did not. Cohorts were propensity score matched on demographic characteristics, pain, mental health, and substance-related diagnoses. Primary outcome was risk of persistent opioid use 3-9 months post-operatively. Secondary outcomes included risk of ED or office/outpatient visit 30- and 90-days post-operatively.

Each cohort contained 1036 patients following application of exclusion criteria and propensity score matching. Post-operative Oxycodone, Hydrocodone, or Codeine had a 3-fold increase in risk of persistent opioid use at 3-9 months (15.15% vs 4.92%, RR=3.08, 95% CI=[2.27-4.17]). Risk of ED or office visits was not significantly lower in patients receiving these opioids.

Opioid prescriptions following AUS placement increase risk of persistent opioid use without lowering the risk of ED or outpatient visits. These findings highlight the necessity for opioid-sparing approaches to post-operative pain control following AUS placement.