Opioid-free discharge not linked with greater readmission following kidney cancer surgery

In this video, Katherine Wang, MD, shares notable findings from the Urology Practice study “Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis.” Wang is a research fellow in the department of urology at Henry Ford Health System in Detroit, Michigan.

Transcription:

What were some of the notable findings? Were any of them surprising to you and your coauthors?

The study was done between April 2021 to 2023, so a 2-year span. It was surprising to find that 24% of our patients in that time span had opioid-free discharge. It was surprising because it was a lot more than we expected. At Henry Ford, we don't have any opioid-free discharge protocols implemented. Maybe they are implemented at other practices throughout Michigan; we're just not sure. But it ranged from 6.7% to 55% in practices, and so a practice that has more than half of their patients being discharged without opioid medications, that's very impressive and very surprising to us. Additionally, we also looked at any predictive factors, so what kind of patients are more likely or less likely to have opioid-free discharge. And another surprising thing that we found was that patients with T1 renal masses, which are renal masses between 4 to 7 cm, were actually more likely to have opioid-free discharge. Initially, that was surprising, but we looked a little deeper, and we saw that these patients were more likely to have radical nephrectomy, which is a shorter surgery compared with partial nephrectomy. That may lead to less pain down the line. And additionally, these patients stayed in the hospital for longer. One of the things that we couldn't look at in our database is whether or not these patients got opioids during their stay in the hospital. If you stay in the hospital for longer after surgery, you tend to have better pain control when you're discharged. And so that's one of the contributing factors to this surprising finding. And so just taking all that into account, it made a lot more sense. One of the most important things that we found was that there was no significant difference in emergency department and readmissions between the 2 groups. This was actually very encouraging to us because one of the concerns of opioid-free discharge is whether or not these patients would present more to the emergency room or to be readmitted because of pain. And actually, that was not a finding that we found. Patients with opioids and without opioids at discharge presented to the emergency room and were readmitted pretty equally. It was encouraging to note that there was no difference between the 2 groups.

This transcription was edited for clarity.