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

Ryan J Davis1, Marissa Maas2, David Ginsberg2

  • 1Keck School of Medicine of the University of Southern California, Los Angeles, CA.

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Post-operative opioid prescriptions after artificial urinary sphincter (AUS) implantation significantly increase the risk of persistent opioid use. These prescriptions do not reduce emergency department or outpatient visits, highlighting the need for opioid-sparing pain management strategies.

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Area of Science:

  • Urology
  • Pain Management
  • Pharmacovigilance

Background:

  • Artificial urinary sphincter (AUS) implantation is a surgical procedure requiring post-operative pain management.
  • The use of opioids for post-operative pain control is common but carries risks of dependence and adverse events.
  • Understanding the long-term consequences of opioid use after AUS placement is crucial for patient safety.

Purpose of the Study:

  • To evaluate the association between post-operative opioid prescriptions and persistent opioid use following AUS implantation.
  • To assess the impact of post-operative opioid use on emergency department (ED) and office/outpatient visits after AUS surgery.
  • To identify the need for opioid-sparing pain management strategies in the context of AUS implantation.

Main Methods:

  • A nationwide claims database (TriNetX US Collaborative Network) was utilized, encompassing over 115 million patients.
  • Males undergoing first-time AUS placement between 2010-2024 were identified, with specific exclusion criteria applied.
  • Propensity score matching was employed to compare cohorts receiving or not receiving post-operative opioids, controlling for various patient characteristics and diagnoses.

Main Results:

  • Opioid prescriptions (Oxycodone, Hydrocodone, or Codeine) post-AUS surgery were associated with a threefold increase in the risk of persistent opioid use (15.15% vs. 4.92%).
  • The risk of persistent opioid use was observed between 3-9 months post-operatively (Risk Ratio = 3.08).
  • No significant reduction in the risk of ED or office/outpatient visits was found in patients receiving post-operative opioids.

Conclusions:

  • Prescribing common opioids after AUS implantation elevates the risk of long-term opioid use.
  • Opioid use post-AUS surgery does not appear to decrease the likelihood of subsequent ED or outpatient visits.
  • The findings underscore the importance of adopting opioid-sparing pain management approaches for patients undergoing AUS placement.