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

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.