Reducing Opioid Utilization After Ureteroscopy Without Compromising Patient Outcomes in a Statewide Quality...

To evaluate the impact on patient-reported outcomes of the efforts by the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative to reduce postoperative opioid use after ureteroscopy.

We evaluated MUSIC ROCKS patients with complete prescription and PRO data. PROMIS pain intensity and interference scores were compared between opioid and non-opioid users using multivariable regression models. A sub-analysis compared opioid users discharged with multimodal therapy and then required rescue opioids versus those given opioid at discharge.

Opioid prescription rates after ureteroscopy declined from 83% in 2016 to 13% in 2023. Of the 405 opioid-naïve ureteroscopy cases; 23% reported opioid use within 7-10 days post-op. At 7-10 days after surgery, patients taking opioids had worse pain intensity and pain interference than those who had not. However, there were no statistically significant differences in PROs between those prescribed opioid at discharge versus those who required rescue opioid. Multivariable predictors of both pain intensity and interference included postoperative opioid use at 7-10 days, postoperative stent placement and preoperative stent use.

Opioid use after ureteroscopy has declined sharply in Michigan. We did not see evidence that PROs differed between patients discharged opioid-free who later required rescue opioids and those discharged with opioids, supporting the use of multimodal regimens. Postoperative stent use, however, was a key predictor of pain, highlighting its modifiable impact on outcomes.