Predictors and Trends of Opioid-Sparing Radical Prostatectomy From a Large National Cohort

Abstract

Objective: To examine the use of pain medications after radical prostatectomy using a large national database.

Methods: The Premier Hospital Database was queried to identify all robotic and laparoscopic radical prostatectomies from January 2015 to March 2020 with length of stay more than or equal to 1 day. "Opioid-sparing" was defined as absence of intravenous opioid use after post-operative day 0 and absence of oral opioid use throughout admission. Comparisons were made between opioid-sparing and non-opioid-sparing prostatectomy. Logistic multivariable regression was used to identify predictors of opioid-sparing prostatectomy.

Results: A total of 62,660 patients were included, of whom 14,806 (23.6%) underwent opioid-sparing prostatectomy. Opioid-sparing prostatectomy was associated with older age (65 vs 63 years, P <.01), white versus black race (76.3% vs 73.4%, P <.01), high-volume surgeons (75.2% vs 70.0%, P <.01), and use of intravenous ketorolac (62.2% vs 48.0%, P <.01), intravenous acetaminophen (32.5% vs 30.1%, P <.01), and liposomal bupivacaine (5.4% vs 4.9%, P <.01). On multivariable regression, ketorolac was the strongest predictor of opioid-sparing prostatectomy (odds ratio: 1.86, 95% confidence interval: 1.79-1.93, P <.01), and black race was predictive of non-opioid sparing prostatectomy (odds ratio: 0.75, 95% confidence interval: 0.71-0.80, P <.01). Ketorolac was not associated with increased risk of postoperative bleeding (0.3% vs 0.3%, P =1.0) or dialysis requirement (<0.1% vs <0.1%, P =.91).

Conclusion: Opioid-sparing radical prostatectomy was feasible and associated with administration of each of the non-opioid pain medications assessed. Ketorolac was the strongest predictor of opioid-sparing prostatectomy and was not associated with increased risk of bleeding or dialysis.