Persistent Opioid Use Following Artificial Urinary Sphincter Placement: A Large Claims Database Analysis

Ryan J Davis; Marissa Maas; David Ginsberg; Jay Simhan; Jeffrey Loh-Doyle

doi:10.1016/j.urology.2024.10.003

Persistent Opioid Use Following Artificial Urinary Sphincter Placement: A Large Claims Database Analysis

Urology. 2024 Oct 17:S0090-4295(24)00869-0. doi: 10.1016/j.urology.2024.10.003. Online ahead of print.

Authors

Ryan J Davis¹, Marissa Maas², David Ginsberg², Jay Simhan³, Jeffrey Loh-Doyle⁴

Affiliations

¹ Keck School of Medicine of the University of Southern California, Los Angeles, CA.
² Keck School of Medicine of the University of Southern California, Department of Urology, Los Angeles, CA.
³ Fox Chase Cancer Center, Department of Urology, Philadelphia, PA.
⁴ Keck School of Medicine of the University of Southern California, Department of Urology, Los Angeles, CA. Electronic address: jeffrey.loh-doyle@med.usc.edu.

PMID: 39424233
DOI: 10.1016/j.urology.2024.10.003

Abstract

Objective: To assess risk of persistent opioid use and emergency department (ED) and office/outpatient visits following post-operative prescriptions of common opioids in patients following artificial urinary sphincter (AUS) implantation using a nationwide claims database.

Methods: The TriNetX US Collaborative Network, which encompasses over 115 million patients from 66 healthcare organizations was used to identify males who underwent first-time AUS placement between 2010-2024. Patients with history of opioid dependence/abuse, opioid use within 6 months prior to AUS placement, or surgery within 9 months post-operation were excluded. Patients were distributed into 2 cohorts: those who received opioids post-operatively or those that did not. Cohorts were propensity score matched on demographic characteristics, pain, mental health, and substance-related diagnoses. Primary outcome was risk of persistent opioid use 3-9 months post-operatively. Secondary outcomes included risk of ED or office/outpatient visit 30- and 90-days post-operatively.

Results: Each cohort contained 1036 patients following application of exclusion criteria and propensity score matching. Post-operative Oxycodone, Hydrocodone, or Codeine had a 3-fold increase in risk of persistent opioid use at 3-9 months (15.15% vs 4.92%, RR=3.08, 95% CI=[2.27-4.17]). Risk of ED or office visits was not significantly lower in patients receiving these opioids.

Conclusion: Opioid prescriptions following AUS placement increase risk of persistent opioid use without lowering the risk of ED or outpatient visits. These findings highlight the necessity for opioid-sparing approaches to post-operative pain control following AUS placement.