Persistent Opioid Use Following Artificial Urinary Sphincter Placement: A Large Claims Database Analysis

OBJECTIVE: To assess risk of persistent opioid use and emergency department (ED) and office/outpatient visits following post-operative prescriptions of common opioids in patients following artificial urinary sphincter (AUS) implantation using a nationwide claims database.

METHODS: The TriNetX US Collaborative Network, which encompasses over 115 million patients from 66 healthcare organizations was used to identify males who underwent first-time AUS placement between 2010-2024. Patients with history of opioid dependence/abuse, opioid use within 6 months prior to AUS placement, or surgery within 9 months post-operation were excluded. Patients were distributed into 2 cohorts: those who received opioids post-operatively or those that did not. Cohorts were propensity score matched on demographic characteristics, pain, mental health, and substance-related diagnoses. Primary outcome was risk of persistent opioid use 3-9 months post-operatively. Secondary outcomes included risk of ED or office/outpatient visit 30- and 90-days post-operatively.

RESULTS: Each cohort contained 1036 patients following application of exclusion criteria and propensity score matching. Post-operative Oxycodone, Hydrocodone, or Codeine had a 3-fold increase in risk of persistent opioid use at 3-9 months (15.15% vs 4.92%, RR=3.08, 95% CI=[2.27-4.17]). Risk of ED or office visits was not significantly lower in patients receiving these opioids.

CONCLUSION: Opioid prescriptions following AUS placement increase risk of persistent opioid use without lowering the risk of ED or outpatient visits. These findings highlight the necessity for opioid-sparing approaches to post-operative pain control following AUS placement.