Opioid Prescribing for Kidney Stone Formers Undergoing Stone Removal

Abstract

Background: Kidney stone formers may have episodes of severe pain and be at increased risk of narcotic use. Alabama has a high rate of opioid use. Within, we examine differences in opioid prescribing for kidney stone formers requiring stone removal procedures.

Methods: A retrospective review was conducted from June 2013 to July 2019. Twenty-five patients with recurrent cystine stones were randomly matched by age, gender, and procedure to 25 recurrent non-cystine and 25 first-time non-cystine stone formers. Patients underwent ureteroscopic stone removal and percutaneous nephrolithotomy. Opioids prescribed were identified through medical record review and the prescription drug monitoring program (PDMP) database. Morphine milligram equivalents (MMEs) standardized opioid utilization.

Results: Opioids prescribed at discharge significantly decreased (mean MME SD), 216.8 125.9 for 2013 - 2016 and 124.2 106.1 for 2017 - 2019 (P < 0.001) corresponding to implementation of an institutional opioid stewardship program. Opioids prescribed within 180 days of stone removal were similar amongst all three cohorts, mean 3,377.6 MME/patient. Over this 6-year time period, there was no difference in total amount of opioids prescribed for each cohort, mean 27,987.8 MME. The majority of prescriptions (56.4%) and MME prescribed (91.9 %) were from pain management and primary care providers.

Conclusions: MME prescribed for stone removal in an environment of high utilization has not declined and is not influenced by stone disease complexity. An opioid stewardship program was associated with decreased opioids prescribed by the surgeons conducting stone removal but had a negligible overall influence. The latter is driven by other care providers.

World J Nephrol Urol. 2022;11(1):10-17
doi: https://doi.org/10.14740/wjnu428