The historical controls were taken from retrospective chart review of patients undergoing ureteroscopy for urinary calculi from October 1st, 2017 to February 1st, 2018, performed at the same institution by the same 2 trained surgeons (neither had fellowship training in endourology) while residents participating did differ. We performed a prospective cohort study of all patients undergoing ureteroscopy for urinary calculi from June 20th, 2019 to September 20th, 2019 at a major academic stone center and compared them to a historical control group. We sought to initiate a pilot study for ureteroscopy for urinary calculi as part of a departmental quality improvement project to test the feasibility of an opioid-free discharge in our patient population. Attempts to evaluate this are limited however, 2 prior studies have suggested the feasibility of an opioid-free discharge after ureteroscopy without negatively affecting outcomes. The type of pain following ureteroscopy can lend itself to be controlled with multimodal nonopioid based methods. Therefore, the optimal pain control after ureteroscopy remains unknown. While recent guidelines on the use of opioids following endourologic procedures have been published, these remain broad in their recommendations.
Additionally, patients who receive a prescription are more likely to use an opioid and those who receive more morphine equivalent doses (MEDs) per prescription use more pills. There is high risk of continued chronic opioid use, with 6% risk of chronic use after ureteroscopy. Evidence suggests that opioids are over prescribed, with an average prescription containing enough opioids for 10 days of postoperative pain control. There is wide variation in opioid prescriptions given following stone surgery. Ureteroscopy is now the most common treatment of urinary calculi, with more than 400,000 upper tract procedures done for urinary calculi from 2003 to 2012. The practice of prescribing opioids after surgery is a uniquely American pattern and many of these medications will go unused. As deaths related to opioid use are increasingly common – surpassing the number of deaths related to kidney cancer and bladder cancer combined – urologists can no longer ignore the crisis. This epidemic has the potential to worsen as the number of prescriptions for opioid medications has increased from 76 million prescriptions in 1991 to more than 200 million in 2011 along with a parallel rise in opioid-related deaths. The opioid epidemic is a public health crisis which has been demonstrated to be both deadly and costly within the United States healthcare system.
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