OBJECTIVES : Opioid analgesia is commonly used for treating postoperative pain. Up to one third of chronic users received an initial opioid prescription in the post-operative setting. Minimally invasive surgery offers the potential for reduced post-operative pain and opioid use. We sought to compare the incidence of prolonged opioid use after open and robotic-assisted radical prostatectomy.

METHODS : We performed a retrospective cohort study of adult males from the Truven MarketScan claims database who were opioid-naïve (no opioid prescriptions from 180 to 30 days prior to the index surgery) and underwent radical prostatectomy for prostate cancer from 2013 to 2016. Patients were followed up to 180 days after surgery to evaluate the incidence of perioperative opioid use (≥1 prescription(s) between 30 days before and 14 days after surgery) and prolonged post-operative opioid use (≥1 prescription(s) between 90 and 180 days after surgery). Multivariable logistic regression was performed to investigate the association between surgical approach and prolonged opioid use after controlling for relevant covariates.

RESULTS : A total of 7787 opioid-naïve patients were identified: 999 (13%) underwent open and 6788 (87%) underwent robotic-assisted radical prostatectomy. Overall, 6615 patients (85%) filled at least one perioperative opioid prescription. Of these, 451 (6.8%) patients filled one or more additional opioid prescriptions between 90 and 180 days after surgery. Patients undergoing robotic-assisted radical prostatectomy were 33% less likely to develop prolonged opioid use compared to those undergoing open radical prostatectomy (6.5% vs. 9.3%) (adjusted odds ratio 0.67; 95% confidence interval 0.52-0.87).

CONCLUSIONS : Approximately 6.8% of opioid-naïve patients continue to fill opioid prescriptions between 90 and 180 days after prostatectomy. The risk of prolonged opioid use is significantly lower among patients undergoing robotic-assisted radical prostatectomy as compared to open. Further efforts are needed to develop opioid-sparing perioperative care protocols to reduce prolonged opioid use among patients undergoing radical prostatectomy.