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You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety IV (MP83)1 Apr 2020


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    Studies indicate that opiates are frequently prescribed after ureteroscopy (URS) and can lead to dependence. Efforts have been made to move to an opiate-free (OF) pathway following URS at our institution. The impact of this pathway on patient reported outcomes (PRO) is both important and unclear. We sought to determine the impact of an OF pathway on PRO.


    We prospectively administered the PROMIS® (Patient-Reported Outcomes Measurement System) questionnaire to adult patients undergoing URS for stone disease at our institution (9/2019 – 10/2019). This validated instrument measures both pain intensity and interference. PROMIS was completed preoperatively and again on postoperative day 7 to 10. Raw scores were translated into normed T-scores with a T-score of 50 considered the reference population mean and a score of 60 considered 1 standard deviation above the mean. Patients were placed on an OF pathway at the discretion of the treating urologist. Clinical and operative characteristics were abstracted by chart review. We used bivariate statistics to compare T-scores pre- and postoperatively in those who were and were not OF. We also assessed if an OF pathway was associated with a higher rate of more severe postoperative pain (T-scores >60).


    54 patients completed both the pre and postoperative PROMIS® survey (62% response rate). An OF pathway was used in 81% of cases. OF patients were similar to non-OF with regard to mean stone size (7.1mm vs 6.9mm; p=0.9) and rate of postoperative stent placement (61% vs 60%; p=0.9). Mean pre-operative T-scores for OF and non-OF patients were similar for both intensity (48.8 vs 50.2, p=0.7) and interference (59.2 vs 60.9, p=0.6). These findings persistent postoperatively (intensity: 46.6 vs 49.4, p=0.4; interference: 58.8 vs 61.6, p=0.5) (Figure). OF patients did not have significantly higher rates of a post-operative T-score >60 compared to non-OF with regard to intensity (12% vs 10%, p=1) and interference (53% vs 60%, p=1).


    Implementation of an OF pathway following URS does not appear to negatively impact PRO. Further utilization of such validated instruments across a wider swathe of practices will offer additional insight into the patient experience following URS.

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