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Comparative Study
. 2021 Jan;62(1):56-64.
doi: 10.4111/icu.20200194. Epub 2020 Nov 13.

Recovery from minimally invasive vs. open surgery in kidney cancer patients: Opioid use and workplace absenteeism

Marieke J Krimphove #  1   2 , Stephen W Reese #  1 , Xi Chen  1 , Maya Marchese  1 , Daniel Pucheril  1 , Eugene Cone  1 , Wesley Chou  1 , Karl H Tully  1   3 , Adam S Kibel  1 , Richard D Urman  4 , Steven L Chang  1 , Luis A Kluth  2 , Prokar Dasgupta  5 , Quoc Dien Trinh  6
Affiliations
Comparative Study

Recovery from minimally invasive vs. open surgery in kidney cancer patients: Opioid use and workplace absenteeism

Marieke J Krimphove et al. Investig Clin Urol. 2021 Jan.

Abstract

Purpose: Does surgical approach (minimally invasive vs. open) and type (radical vs. partial nephrectomy) affects opioid use and workplace absenteeism.

Materials and methods: Retrospective multivariable regression analysis of 2,646 opioid-naïve patients between 18 and 64 undergoing radical or partial nephrectomy via either a minimally invasive vs. open approach for kidney cancer in the United States between 2012 and 2017 drawn from the IBM Watson Health Database was performed. Outcomes included: (1) opioid use in opioid-naïve patients as measured by opioid prescriptions in the post-operative setting at early, intermediate and prolonged time periods and (2) workplace absenteeism after surgery.

Results: Patients undergoing minimally invasive surgery had a lower odds of opioid use in the early and intermediate post-operative periods (early: odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62-0.97; p=0.02, intermediate: OR, 0.60; 95% CI, 0.48-0.75; p<0.01), but not in the prolonged setting (prolonged: OR, 1.00; 95% CI, 0.75-1.34; p=0.98) and had earlier return to work (minimally invasive vs. open: -10.53 days; 95% CI, -17.79 to -3.26; p<0.01). Controlling for approach, patient undergoing partial nephrectomy had lower rates of opioid use across all time periods examined and returned to work earlier than patients undergoing radical nephrectomy (partial vs. radical: -14.41 days; 95% CI, -21.22 to -7.60; p<0.01).

Conclusions: Patients undergoing various forms of surgery for kidney cancer had lower rates of peri-operative opioid use, fewer days of workplace absenteeism, but no difference in long-term rates of opioid use in patients undergoing minimally invasive as compared to open surgery.

Keywords: Absenteeism; Kidney neoplasm; Minimally invasive surgical procedures; Nephrectomy; Opioids.

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Conflict of interest statement

Quoc-Dien Trinh reports personal fees from Astellas, Bayer, Janssen, Insightec and Intuitive Surgical. Adam S. Kibel reports consulting fees from Janssen, Merck, Bristol-Myers Squibb, Advantage, Insightec, and Profound. Richard D. Urman reports research funding from Merck and Medtronic and consulting fees from 3M, Mallinckrodt and Sandoz. Prokar Dasgupta is funded by the MRC Centre for Transplantation, NIHR Biomedical Research Centre, Kings College London, The Prostate Cancer Research Centre, The Vattikuti Foundation and The Urology Foundation.

Figures

Fig. 1
Fig. 1. Percent opioid prescriptions at measured post-operative time periods.
See this image and copyright information in PMC

References

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