Opioid use after nephrectomy for kidney cancer in Ontario: a population-based study

Urology. 16 February 2022: S0090-4295(22)00143-1. doi: 10.1016/j.urology.2022.02.002. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the odds of early and prolonged postoperative opioid use in patients undergoing minimally invasive surgery (MIS) versus open surgery for nephrectomy.

METHODS: For opioid-naïve patients in Ontario who underwent nephrectomy for kidney cancer (1994-2017, n=7900), post-discharge opioid use was determined by prescriptions in the database from the Ontario Drug Benefit Program (age ≥ 65 years) and the Narcotics Monitoring System (all patients from 2012). Early opioid use was defined as ≥ 1 prescription 1 to 90 days after surgery. Two distinct definitions of prolonged opioid use were examined: (1) prescription(s) for ≥ 60 days during postoperative days 90-365; (2) ≥ 1 prescription between: 1-90 days AND 91-180 days after surgery. Predictors of opioid use were assessed using multivariate generalized estimating equation logistic regression, controlling for surgeon clustering.

RESULTS: Overall, 67.4% of patients received early opioid prescriptions; however, prolonged use was low, ranging from 1.6 to 4.4% of patients depending on the definition. In a multivariate analysis, open nephrectomy was associated with a higher likelihood of early opioid use compared to MIS nephrectomy (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.19-1.55). Type of surgery was not significantly associated with prolonged opioid use for either definition (OR 1.22, CI 0.79 1.89 and OR 1.06, CI 0. 83, 1.35).

CONCLUSIONS: In this population-level study of patients undergoing nephrectomy for kidney cancer, patients who underwent open surgery were more likely to receive early postoperative opioids compared to those who underwent MIS. Long-term opioid use was low overall and not significantly associated with type of surgery.

PMID:35182588 | DOI:10.1016/j.urology.2022.02.002