Introduction:
Urologic and general surgical data have shown in numerous settings that opioid-naïve patients prescribed postoperative opioids are at increased risk of developing opioid dependence and persistent use. Bladder cancer patients represent a high-risk group due to the frequency of multiple surgical procedures, uncomfortable intravesical therapies, and radical therapy. Surgeon variability in opioid prescribing post-operatively suggests that routine use of opioids following transurethral resection of bladder tumor (TURBT) may still be common, despite increasing awareness of opioid dependence, addiction, and adverse outcomes. Using MarketScan insurance commercial claims (CC) and the MarketScan Medicare-eligible (ME) supplemental database, we sought to identify whether receiving initial post-TURBT opioids (IPTO) resulted in an increased likelihood of prolonged use. We additionally sought to identify opioid prescribing trends over time and in different treatment groups.
Methods:
This insurance claims review analyzed 31,395 CC and 33,333 ME patients with a new diagnosis of bladder cancer, verified insurance claims for medications, and no opioid prescriptions for 6 months prior to initial TURBT from 2009 to 2019. MarketScan CC and ME populations were analyzed independently. We compared those who received an opioid prescription at the time of TURBT (CC: n=7,574 (24.1%); ME: n=5,577 (16.7%)) to those who did not. We further assessed the initial dose of opioids in oral morphine equivalents (OME) and performed subgroup analyses by gender and in those who eventually underwent radical therapy.
Results:
Multivariate regression analysis revealed that those who received IPTO were more likely to fill additional prescriptions between 3-6 months (CC: OR 1.20 95% CI(1.12-1.29); ME: OR 1.29, 95% CI(1.20-1.40)). Ordinal data analysis revealed median OME values of 150.0 for both CC and ME groups, the equivalent of 20 oxycodone 5mg pills. Increasing quartile OME of IPTO predicted increased odds of prolonged opioid use (figure 1). The odds of an opioid refill within the month after initial TURBT were higher for those who underwent future radical or non-radical therapy compared to those with no further treatment (figure 2). The rates of IPTO, prolonged use, and OMEs were similar for CC men and women, but ME women received higher median OME prescriptions at 2-3 months (210.0 vs. 187.5) and 3-6 months (270.0 vs. 216.3), both p<.001. ME men were less likely to have prolonged use at 3-6 months (OR 0.92 95% CI(0.86-0.98).
Conclusion:
Utilizing national insurance claims data in both Medicare-eligible and commercial claims groups provides the ability to assess contemporary opioid prescribing patterns and predictors of prolonged opioid use in bladder cancer patients. These results suggest that prescribing initial post-TURBT opioids increases the likelihood of continued use at 3-6 months. Those who go on to radical treatment are refilling opioids at a higher rate than others at one month. Medicare-eligible men were receiving lessor quantities of opioids in the months following TURBT and were less likely to have prolonged use. These data suggest that short-term prescriptions have long-term effects, and additional research on surgical outcomes, oncologic outcomes, and opioid dependence is merited.
Funding: N/A
Image(s) (click to enlarge):
PROLONGED OPIOID USE FOLLOWING TURBT: INSURANCE CLAIMS REVIEW OF HIGH-RISK PRESCRIBING TO OPIOID-NAÏVE PATIENTS
Category
Bladder Cancer > Other
Description
Poster #12
Wednesday, Dec 1
1:00 p.m. - 2:00 p.m.
Bladder 1
Presented By: Benjamin Croll
Authors:
Benjamin Croll, MD
Datta Patil, MBBS
Misaki Mason, BA
Vikram Narayan, MD
Viraj Master, MD, PhD
Christopher Filson, MD, MS
Shreyas Joshi, MD