OBJECTIVES: Postsurgical opioid prescribing is a major contributor to the United States opioid epidemic. There is limited research on real-world postsurgical opioid prescribing patterns, especially for urologic procedures. This study aimed to compare the incidence of opioid prescribing following benign prostatic hyperplasia (BPH) procedures.

METHODS: This retrospective cohort analysis included men undergoing BPH procedures requiring and not requiring an operating room (OR) from 2015-2020. The cohort was identified using a 10% random sample from the IQVIA PharMetrics® Plus Database. Primary outcomes were any prescription of opioids and cumulative days of opioids prescribed in the 14-180 days following surgical intervention. Inverse probability of treatment weights controlled for observed baseline confounders. Any opioid prescription was estimated using logistic regression and generalized linear regression for cumulative days of opioids prescribed.

RESULTS: Of 6022 men who underwent a BPH procedure, 1463 received non-OR procedures and 4473 underwent OR procedures. Post-operatively, 42.78% of men within the OR procedure group received an opioid compared to 28.00% of men in the non-OR procedure group (p<.0001). Men undergoing a BPH procedure requiring an OR had a significantly higher odds (1.922;95%CI 1.690-2.185) of receiving an opioid prescription. Mean cumulative days of post-procedure opioid prescribing was 112.25 (SD=490.33) in the non-OR group and 72.63 (SD=337.72) in the OR group. The generalized linear regression indicated that the mean cumulative days of opioids dispensed was not statistically different between groups.

CONCLUSIONS: Men undergoing a BPH procedure in the OR are more likely to receive post-procedural opioid prescriptions compared to non-OR procedures. The cumulative prescription length, however, does not vary between groups despite non-OR procedures being considered less invasive. Interventions in mitigating opioid prescribing beyond the 14 days following a BPH procedure may be beneficial given the association of prolonged opioid use with life threatening adverse events.