Postoperative opioid-free ureteroscopy discharge: A quality initiative pilot protocol

Alex M Kasman, Bogdana Schmidt, Kyle Spradling, Charlene Chow, Rebecca Hunt, Mechele Wu, Alexa Sockol, Joseph Liao, John T Leppert, Jay Shah, Simon L Conti, Alex M Kasman, Bogdana Schmidt, Kyle Spradling, Charlene Chow, Rebecca Hunt, Mechele Wu, Alexa Sockol, Joseph Liao, John T Leppert, Jay Shah, Simon L Conti

Abstract

Background: Opioids are commonly prescribed after ureteroscopy. With an increasing adoption of ureteroscopy for management of urolithiasis, this subset of patients is at high risk for opioid dependence. We sought to pilot an opioid-free discharge protocol for patients undergoing ureteroscopy for urolithiasis.

Materials and methods: A prospective cohort study was performed of all patients undergoing ureteroscopy for urolithiasis and compared them to a historical control group. An opioid-free discharge protocol was initiated targeting all areas of surgical care from June 20th, 2019 to September 20th, 2019 as part of an institutional quality improvement initiative. Demographic and surgical data were collected as were morphine equivalent doses (MEDs) prescribed at discharge, postoperative measures including phone calls, clinic visits, and emergency room visits for pain.

Results: Between October 1st, 2017 and February 1st, 2018, a total of 54 patients who underwent ureteroscopy were identified and comprised the historical control cohort while 54 prospective patients met the inclusion criteria since institution of the quality improvement initiative. There were no statistically significant differences in baseline patient demographics or surgical characteristics between the 2 patient groups. Total 37% of the intervention group had a preexisting opioid prescription versus 42.6% of the control group with no difference in preoperative MED (p = 0.55). The intervention group had a mean MED of 12.03 at discharge versus 110.5 in the control cohort (p ≤ 0.001). At discharge 3.7% of the intervention group received an opioid prescription versus 88.9% of the control group (p < 0.001). Overall, there was no difference in postoperative pain related phone calls (p = 1.0) or emergency room visits (p = 1.0).

Conclusions: An opioid-free discharge protocol can dramatically reduce opioid prescription at discharge following ureteroscopy for urinary calculi without affecting postoperative measures such as phone calls, clinic visits, or subsequent prescriptions.

Keywords: Opioid free; Opioid sparing; Ureteroscopy.

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
Opioid-free ureteroscopy discharge protocol. AVS = after-visit summary; B&O = belladonna and opium; GFR = glomerular filtration rate; IV = intravenous; NSAID = nonsteroidal anti-inflammatory drug; PACU = postanesthesia care unit; PO = per os; RN = registered nurse.

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