Preliminary data from a feasibility study conducted at the University of Vermont Medical Center was presented at the 2018 American Urological Association (AUA) meeting in San Francisco. A manuscript of this single center experience to the Journal of Urology is currently under review. Earlier data was presented at the 2017 New England Section of the AUA meeting in Montreal, CA and the the 2017 World Congress of Endourology in Vancouver, CA.
The feasibility of discharging patients without opioids after ureteroscopy
David W Sobel, MD; Theodore Cisu, BS; Tessa Barclay, BA; Peter Callas, PhD; Kevan Sternberg, MD. University of Vermont Medical Center, Burlington, VT.
Purpose: Efforts have begun to implement non-opioid protocols for outpatient urologic surgery. In this study, we report our single center experience demonstrating the feasibility of implementing a non-opioid protocol to manage postoperative pain after ureteroscopy with stent placement.
Methods: Between November 2016 and March 2017, 206 patients underwent ureteroscopy with stent placement by a single surgeon at an academic medical center. A treatment algorithm was used to determine eligibility and appropriately select patients for the non-opioid pathway. Frequency of postoperative events were reviewed and included visits to the emergency department (ED), telephone calls to the clinic, and requests for prescription refills.
Results: Of 206 patients, 151 were discharged without opioid medications (73%) and 55 received opioids (27%). Of those discharged without an opioid, 129 received diclofenac and 22 did not receive any pain medication. A similar percentage of patients receiving opioids and non-opioids had postoperative visits to the ER for genitourinary-related concerns (7 patients receiving opioids (13%) and 15 patients without opioids (10%); p=0.61). Patients in the non-opioid group made significantly fewer telephone calls (25 patients receiving opioids (45%) and 32 patients without opioids (21%); p=0.001). The number of pain medication refill requests was also significantly fewer among patients given non-opioids (13 patients receiving opioids (24%) and 11 patients without opioids (7%); p=0.003).
Conclusion: Our experience using a non-opioid pathway post URS reveals that approximately 3/4 of patients can be discharged without opioids. Patients receiving non-opioid therapies had similar postoperative adverse events with overall lower impact on outpatient resource utilization.