(246) Risk for Prolonged Opioid Usage after Inflatable Penile Prosthesis, A Global Analysis
Authors: Prebay Z , Ebbott D , Li M , Chung P 
Published: May 2023

Abstract

Introduction
Urologists are not immune from the opioid epidemic. While narcotics still have a role to play in postoperative pain management, examining individual surgeries, such as inflatable penile prosthesis placement (IPP), to identify opportunities to limit opioid use should be a priority.

Objective
By querying a large, global research network, we sought to evaluate the impact of a narcotic prescription on short term patient outcomes and long-term opioid use following IPP placement.

Methods
TriNetX is a collaborative research enterprise which collects real-time data from almost 89 million patients located in 58 healthcare organizations across the globe and analyzes patient data from 20 years back to present (2002-2022). We queried TriNetX for all adult patients undergoing IPP. The index event was surgery. Cohorts included patients prescribed oxycodone within 2 days of surgery, tramadol within 2 days of surgery, or one of many frequently prescribed oral opioids (oxycodone, hydrocodone, hydromorphone, oxymorphone or tramadol) within 2 days of surgery. The control cohorts were patients not prescribed a narcotic in the same timeframe. TrinetX identifies prescriptions using RxNorm Concept Unique Identifier, part of the Unified Medical Language System. We also compared patients taking opioids within 6 months to 1 day prior to surgery against “opioid naive” patients. Our short-term outcome was the rate of return visits to the Emergency Department (ED) within 90 days of the index event. Our long-term outcomes were a diagnosis of opioid abuse (ICD-10 F11.1) or dependence (ICD-10 F11.2) disorder 6 months or later after surgery, and we also evaluated persistent opioid use 9 to 15 months after surgery, consistent with previous literature. Propensity score matching (PSM) was performed on potential cofounders: age, race, mental and behavioral disorders, pain disorders, and prior opioid use. The analyses were performed on June 28th, 2022.

Results
There were 9702 patients who received an IPP (Table 1). Patients considered opioid- or oxycodone naive were less likely to have a diagnosis of opioid dependence or abuse (Relative Risk (RR)=0.51 and RR=0.42) at 6 months. Patients prescribed an opioid postoperatively, or oxycodone or tramadol specifically, were more likely have persistent opioid, oxycodone, or tramadol use (all p&lt;0.05) at 9 to 15 months, except for patients prescribed postoperative tramadol for the outcome of any oral opioid prescription (p=0.75). Patients prescribed any opioid or oxycodone specifically were more likely to have an ED visit (RR=1.5 and 1.3) while patients prescribed tramadol postoperatively showed no difference in ED visits (RR=1.2). There was no significant difference in ED visits based on opioid naivety, while all patients taking preoperative opioids were more likely to continue taking an opioid at 9 to 15 months (all p&lt;0.01).

Conclusions
The prescription of opioids after IPP has risks of long-term opioid use and prescribing opioids in general may increase healthcare utilization in the short term. Prescribing a partial agonist, such as tramadol, may reduce persistent opioid use while being non-inferior in need to return to the emergency department when compared to oxycodone; however, a non-opioid regimen is preferred to maximally reduce risk.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast