Robotic-Assisted Radical Prostatectomy Associated With Decreased Persistent Postoperative Opioid Use. - UroToday

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Minimally invasive surgery offers reduced pain and opioid use postoperatively compared to open surgery, but large-scale comparative studies are lacking. We assessed the incidence of persistent opioid use after open and robotic-assisted radical prostatectomy.

We performed a retrospective claims database cohort study of opioid-naive (i.e., no opioid prescriptions 30-180 days before index surgery) adult males who underwent radical prostatectomy for prostate cancer from July 2013-June 2017. For patients who filled a perioperative opioid prescription (30 days before to 14 days after surgery), we calculated the incidence of new persistent postoperative opioid use (≥1 prescription 90-180 days after surgery). Multivariable logistic regression was performed to investigate the association between surgical approach, patient risk factors and persistent opioid use.

12,278 radical prostatectomy patients filled an opioid prescription perioperatively (1510 [12%] open, 10,768 [88%] robotic-assisted). Of these, 846 (6.9%) patients continued to fill opioid prescription(s) 90-180 days after surgery. Patients undergoing robotic-assisted radical prostatectomy were 35% less likely to develop new persistent opioid use compared to those undergoing open radical prostatectomy (6.5% vs 9.7%; adjusted OR 0.65; 95% CI 0.54-0.79). Other independent risk factors included living in the southern, western or northcentral United States, preoperative comorbidity and tobacco use.

Approximately 6.9% of opioid-naive patients continued to fill opioid prescriptions 90 days after radical prostatectomy. The risk of persistent opioid use was significantly lower among patients undergoing a robotic-assisted versus open approach. Further efforts are needed to develop postoperative opioid prescription protocols for patients undergoing radical prostatectomy.

Journal of endourology. 2020 Feb 17 [Epub ahead of print]

Eugene Shkolyar, I-Fan Shih, Yanli Li, Jaime Wong, Joseph C Liao

Stanford University School of Medicine, 10624, Urology, 300 Pasteur Dr, Stanford, California, United States, 94305; ., Intuitive Surgical Inc, 19727, 1020 Kifer road, Sunnyvale, California, United States, 94086-5301; ., Sunnyvale, United States; ., Palo Alto, United States; ., Stanford, Urology, 300 Pasteur Dr., S-287, Stanford, California, United States, 94305-5118; .

PubMed https://ift.tt/32qaA9t



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