Impact of Mismatched Discharge Opioid Prescriptions on Opioid Refills After Inpatient Urologic Surgery

This study investigates the impact of discharge opioid prescriptions on opioid refills after inpatient urologic surgery.

We conducted a retrospective cohort study of 7381 adult patients who underwent inpatient urologic surgery from 2017 to 2024. The daily dosage of discharge opioid prescriptions was compared with inpatient opioid consumption during the last 24 hours before discharge. Discharge opioid prescriptions were categorized as matched if the discharge daily dose was within 7.5 oral morphine equivalents (OME) of the inpatient daily consumption, overprescribed if ≥ 7.5 OME above, or underprescribed if ≤ 7.5 OME below.

Multiple logistic regression analyses revealed that the daily dose overprescription was associated with increased odds of opioid refills at 1 to 30 (odds ratio [OR] 1.85, 95% CI: 1.53-2.24), 31 to 60 (OR 1.49, 95% CI: 1.15-1.93), and 61 to 90 (OR 1.85, 95% CI: 1.41-2.45) days after discharge and daily dose underprescription was associated with increased odds of opioid refills at 1 to 30 (OR 1.33, 95% CI: 1.05-1.67) and 61 to 90 (OR 1.47, 95% CI: 1.07-2.04) days after discharge. The total dose of discharge opioid prescriptions was not associated with opioid refills. From 2017 to 2024, while the percentage of patients receiving daily dose overprescription decreased, the percentage of patients receiving daily dose underprescription increased.

Mismatched discharge opioid prescriptions, not the total opioid dose prescribed, were independently associated with increased opioid refill risk after inpatient urologic surgery. Aligning the discharge opioid daily dose with patients' inpatient daily consumption, rather than reducing the total dose alone, may represent a patient-centered approach to reduce opioid refills.