Chronic opioid use is rare following radical prostatectomy (RP) in Europe. Slightly more than half of men undergoing RP in Sweden between 2007 and 2017 were found to have filled an opioid prescription, but the proportion who became chronic opioid users was less than 1%.
Using data from nationwide Swedish registries, Walter Cazzaniga, MD, and colleagues found that preoperative opioid use was the strongest predictor of chronic postoperative use following RP. They presented their findings at the 2019 AUA annual meeting in Chicago and also published research on this topic in the Journal of Urology (2020; 203:145-50).
“Additional study is warranted to optimize the use of opioid and minimize risk of chronic use, particularly for high-risk patients, in the continued efforts to combat the opioid epidemic,” concluded Dr. Cazzaniga, visiting researcher, department of surgical sciences, Uppsala University, Uppsala, Sweden.
Previous data suggest that up to 7% of opioid-naïve patients who receive an opioid prescription after surgical procedures become chronic opioid users, he said. Among a random sample of 10% of patient records from a large U.S. commercial health plan, the probability of continued opioid use was 6.0% at 1 year and 2.9% at 3 years after an opioid prescription following a surgical procedure.
To examine the risk of chronic opioid use following RP, the investigators used data from the Prostate Cancer Data Base Sweden linked to the Prescribed Drug Register to assess opioid prescriptions for 25,703 men who underwent RP from 2007 to 2017. The median age at RP was 64 years. Most men had clinical stage T1c disease, and most were categorized as intermediate risk. Sixty percent of the men underwent robot-assisted RP, 36% had open RP, and 4% had laparoscopic surgery.