An Opioid Prescription for Men Undergoing Minor Urologic Surgery Is Associated with an Increased Risk of New Persistent Opioid Use

Background: The opioid abuse epidemic has highlighted the risks associated with these medications.

Objective: To determine whether filling a postoperative opioid prescription after low acuity urologic surgery is associated with new persistent opioid use.

Design, setting, and participants: A retrospective cohort study was conducted using linked administrative data from Ontario, Canada. Participants were adults who underwent their first vasectomy, transurethral prostatectomy, urethrotomy, circumcision, spermatocelectomy, or hydrocelectomy between 2013 and 2016. We excluded men with prior opioid use, confounding concurrent procedures, prolonged hospitalization, or cancer.

Intervention: Whether the patient filled a prescription for an opioid within 5 d of their surgery.

Outcome measurements and statistical analysis: The primary outcome was evidence of at least two opioid prescriptions filled 9-15 mo after urologic surgery. The secondary outcome was admission for opioid overdose. Primary analysis was adjusted logistic regression analysis.

Results and limitations: We identified 91 083 men, most of whom underwent vasectomy (78%). A total of 32 174 (35%) men filled a prescription for an opioid after their procedure. The most common opioid prescribed was codeine (70%), and urologists were the primary prescribers (81%). Men who filled a postprocedure opioid prescription did not differ, for most of the 57 medical comorbidities or markers of healthcare utilization that we measured, from those who did not fill an opioid prescription. There was long-term opioid use in 1447 (1.6%); men who had filled a postoperative opioid prescription had a significantly higher risk of long-term opioid use (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.6) and opioid overdose (OR 3.0, 95% CI 1.5-5.9). A limitation is that we could not determine the indication for long-term opioid prescriptions.

Conclusions: Prescription of opioids after low acuity urology procedures is significantly associated with increased opioid use at 1yr after surgery; efforts should be made to reduce postoperative opioids, especially for urologic procedures that do not typically require opioids.

Patient summary: Filling an opioid prescription after minor urologic surgeries is associated with an increased risk of persistent long-term use of opioid medications and a higher risk of serious long-term complications such as hospital visits for an opioid overdose.'