title: Comparison of outpatient narcotic prescribing patterns after minimally invasive versus retropubic and perineal radical prostatectomy.
abstract: OBJECTIVE
  Studies comparing pain after minimally invasive vs retropubic and perineal radical prostatectomy are conflicting. We characterized population based outpatient narcotic prescribing patterns after minimally invasive, retropubic and perineal radical prostatectomy.
  
  
  METHODS
  We evaluated outpatient prescription data after minimally invasive, retropubic and perineal radical prostatectomy from 2003 to 2006 using MarketScan®. Baseline and postoperative narcotic prescriptions were identified using the National Drug Code. Total prescribed narcotic strength in morphine sulfate equivalents, the number of prescriptions filled and costs were compared. We performed multivariate analysis adjusted for surgical approach, age, comorbidity, baseline narcotic use, health plan and geographic region.
  
  
  RESULTS
  We identified 2,206 minimally invasive, 8,037 retropubic and 463 perineal radical prostatectomies with no differences in baseline narcotic prescription use. Perineal and retropubic operations were associated with greater total morphine sulfate equivalent use than the minimally invasive operation. Perineal prostatectomy was associated with more narcotic refills than minimally invasive and retropubic prostatectomy (42.3% vs 20.2% and 28.9%, respectively, p <0.001). Median narcotic costs were lower for minimally invasive than for perineal and retropubic prostatectomy. On adjusted analysis perineal radical prostatectomy, younger age, baseline narcotic use and preferred provider organization health plan were associated with greater morphine sulfate equivalents and narcotic refills while minimally invasive surgery was associated with fewer refills and lower costs but not with total morphine sulfate equivalents. There was significant geographic variation in narcotic use and costs.
  
  
  CONCLUSIONS
  Postoperatively minimally invasive radical prostatectomy required fewer narcotic refills and had lower narcotic costs while perineal radical prostatectomy required the greatest amount of narcotics. However, minimally invasive vs retropubic radical prostatectomy morphine sulfate equivalent requirements did not differ on adjusted analysis. While our findings support the purported advantage of minimally invasive radical prostatectomy of less postoperative pain, confirmatory prospective studies with objective outcomes are needed.
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02130, USA. kkowalczyk@partners.org
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Weinburg
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Gu
authors.forename: Hua-Yin
authors.initials: HY
authors.lastname: Yu
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009294:Narcotics / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics; D014481:United States
chemical_list: D009294:Narcotics