Urologic Surgery Tied to Persistent Opioid Usage, Particularly With Tramadol

(Reuters Health) – People who undergo urologic surgery are more likely to have persistent opioid usage afterward than matched non-surgical controls, and patients have a higher risk of persistent use with tramadol than other opioids, a new study suggests.

Researchers examined data on 115,687 patients who had urologic procedures between 2014 and 2017 and filled an opioid prescription within two weeks of discharge. These surgical patients were followed for one year along with a matched 1:3 control group from the general population based on age, gender, and comorbidities.

Over one year of follow-up, 14.8% of the urologic surgery patients had persistent opioid usage, compared with 10.8% of matched controls (odds ratio 1.37).

Urologic surgery patients discharged with tramadol were significantly more likely to have persistent opioid usage (OR 1.23) than their counterparts prescribed other opioids at discharge, the study also found. Patients prescribed tramadol after urologic surgery were also significantly more likely to have persistent opioid usage than the general population (OR 1.54).

“For me, the take-home message is that tramadol should not necessarily be considered less habit forming than other opioids, although further research is needed to substantiate this,” said senior study author Dr. Sarah Faris, an associate professor in the department of urology and urology ambulatory medical director at the University of Chicago.

“Opioids are still opioids and can lead to long term usage regardless of their FDA class,” Dr. Faris said by email.

Persistent opioid usage also varied based on the type of urologic surgery patients had, the study team reports in Urology.

For example, 19.2% of patients had persistent opioid usage after endourologic procedures. By comparison, researchers found persistent opioid usage occurred among 18.4% of patients who underwent percutaneous procedures, 15.8% of patients who had abdominal procedures, and 12% of patients after scrotal, perineal, penile, or vaginal procedures.

One limitation of the study is that opioid prescribing practices vary widely, limiting the generalizability of the results to all types of surgery, the study team notes. Opioids are much more frequently prescribed for pain management after larger, more complex surgeries than they are for urologic and minimally invasive procedures, the authors also point out.

Another limitation is that the data was drawn from a large insurance claims database, with the possibility for administrative or coding errors. This type of data also doesn’t offer detailed clinical information about individual patients that might influence opioid usage.

The effect of tramadol can also vary from one patient to the next because it has highly variable metabolism, said Dr. Chad Brummett, a professor of anesthesiology and co-director of the Opioid Prescribing Engagement Network at the University of Michigan in Ann Arbor.

“For the poor metabolizers, this means tramadol will have no effect, while ultra-rapid metabolizers will get a major high equivalent to intravenous opioids,” Dr. Brummett, who wasn’t involved in the study, said by email.

Even so, urologic surgeons need to be cognizant of the potential for misuse and abuse with opioids and be stewards for safe pain prescribing practices, said Dr. Matthew Ziegelmann, an assistant professor of urology at the Mayo Clinic in Rochester, Minnesota, who wasn’t involved in the study.

“On those occasions when opioids are necessary, we need to use the minimum amount to ensure adequate pain control, and favor alternative approaches if feasible,” Dr. Ziegelmann said by email.

SOURCE: https://bit.ly/3szUF5g Urology, online July 29, 2021.

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