Incidence and predictors of prolonged opioid use following nephrectomy for renal cell carcinoma: A national claims-based study.

OBJECTIVE

To evaluate the incidence rates and risk factors of prolonged opioid use following nephrectomy for non-metastatic renal cell carcinoma (RCC) using a large national insurance database.

METHODS

Marketscan Commercial Claims and Encounters (MCCD) and Medicare Supplemental (MSD) databases were utilized to identify adult patients who underwent nephrectomy for RCC between 2009 and 2023. Patients with prior malignancy, metastatic disease during or within 12 months after surgery, inadequate insurance coverage, missing data, and opioid use within 90 days before surgery were excluded. The cumulative incidence of prolonged opioid use (≥2 prescriptions or ≥60 days of use between postoperative days 90-365) was determined. Multivariable logistic regression analyzed factors independently associated with prolonged opioid use.

RESULTS

10,098 patients from the MCCD and 2,980 from MSD were included. About 78% and 65% of patients received opioids during their early postoperative period in the MCCD and MSD databases, respectively. Prolonged opioid use occurred in 8.2% (MCCD) and 9.4% (MSD) of cases. Across both cohorts, higher comorbidity burden, geographic regions, certain insurance types, and greater early postoperative opioid use were independently associated with prolonged opioid use. In the MCCD cohort, female sex, non-metropolitan residence, and early postoperative emergency department visits were additionally associated with prolonged opioid use. Surgical type and operative approach were not significantly associated with the outcome in either cohort.

CONCLUSION

Almost one in ten patients develops prolonged opioid use following nephrectomy for RCC. Early postoperative opioid exposure appeared strongly associated with prolonged opioid use, demonstrating a clear-dose response relationship. These findings support opioid-sparing strategies and the implementation of perioperative opioid stewardship programs to reduce prolonged opioid use in patients undergoing surgery for non-metastatic RCC.