Opioids are frequently overprescribed after surgery. The 2018 American Urological Association position statement on opioid use suggests using the lowest dose and potency to achieve pain control, but a lack of procedure-specific prescribing guidelines contributes to wide variation in prescribing patterns. To address this gap, this study aims to develop opioid prescribing recommendations through an expert panel consensus.

A 15-member multidisciplinary expert panel included representatives from five stakeholder groups. A three-step modified Delphi method was used to develop recommendations for postsurgical opioid prescribing. Recommendations were made for opioid-naïve patients without chronic pain conditions. The panel used oxycodone 5 mg equivalents to define the number of prescribed tablets.

Procedure-specific recommendations were developed for 16 endourological and minimally-invasive urological procedures. The panel agreed that not all patients desire or require opioids; thus, the minimum recommended number of opioid tablets for all procedures was zero. Consensus ranges were identified to allow alignment of prescribed quantities with expected needs. The maximum recommended quantity varied by procedure, from zero tablets (three procedures) to 15 tablets (six procedures), with a median of 10 tablets. Attending urologists typically voted for higher opioid quantities than non-attending panel members. The panel identified eight overarching strategies for opioid stewardship, including contextualizing postsurgical pain management with patients’ goals and preferences and maximizing non-opioid therapies.

Procedure-specific guidelines for postsurgical opioid prescribing may help to align individual urologists’ prescribing habits with consensus recommendations. These guidelines can aid quality improvement efforts to reduce overprescribing in urology.

The Journal of urology. 2019 Aug 29 [Epub ahead of print]

Kevin Koo, Farzana Faisal, Natasha Gupta, Alexa R Meyer, Hiten D Patel, Phillip M Pierorazio, Brian R Matlaga, Promoting Opioid Stewardship in Endourology Work Group

Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.