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

Area of Science:

• Urology
• Pain Management
• Health Services Research

Background:

• The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative aimed to decrease postoperative opioid use after ureteroscopy.
• Reducing opioid dependence is a key goal in postoperative care.

Purpose of the Study:

• To assess the impact of the MUSIC ROCKS initiative on patient-reported outcomes (PROs) concerning reduced postoperative opioid use after ureteroscopy.
• To compare pain intensity and interference between opioid and non-opioid users post-ureteroscopy.

Main Methods:

• Evaluation of patients from the MUSIC ROCKS initiative with complete prescription and PRO data.
• Comparison of PROMIS pain intensity and interference scores using multivariable regression models.
• Sub-analysis comparing opioid users who required rescue opioids versus those discharged with opioids.

Main Results:

• Opioid prescription rates post-ureteroscopy dropped from 83% (2016) to 13% (2023).
• Among opioid-naïve patients, 23% used opioids 7-10 days post-op, experiencing worse pain intensity and interference.
• No significant PRO differences were found between patients discharged with opioids versus those needing rescue opioids.

Conclusions:

• Opioid use following ureteroscopy has substantially decreased in Michigan.
• Discharging patients opioid-free who later required rescue opioids showed similar PROs to those discharged with opioids, supporting multimodal therapy.
• Postoperative stent use is a significant predictor of pain, indicating a modifiable factor for improving outcomes.