title: Narcotic Use and Postoperative Doctor Shopping by Patients with Nephrolithiasis Requiring Operative Intervention: Implications for Patient Safety.
abstract: OBJECTIVE
  We sought to determine perioperative patterns of narcotic use and the prevalence of postoperative doctor shopping among patients with nephrolithiasis requiring operative management.
  
  
  METHODS
  We retrospectively reviewed the records of consecutive patients residing in Tennessee who required ureteroscopy with laser lithotripsy for nephrolithiasis at a single institution from January to December 2013. Using the Tennessee CSMD (Controlled Substances Medication Database) patients were categorized by the number of postoperative narcotic providers. Doctor shopping behavior was identified as any patient seeking more than 1 narcotic provider within 3 months of surgery. Demographic and clinical characteristics associated with doctor shopping behavior were identified.
  
  
  RESULTS
  During the study period 200 eligible patients underwent ureteroscopy with laser lithotripsy for nephrolithiasis, of whom 48 (24%) were prescribed narcotics by more than 1 provider after surgery. Compared to those receiving narcotics from a single provider, patients with multiple narcotic providers were younger (48.1 vs 54.2 years, p <0.001), less educated (high school education or less in 83.3% vs 58.7%, p = 0.014), more likely to have a history of mental illness (37.5% vs 16%, p <0.01) and more likely to have undergone prior stone procedures (66% vs 42%, p <0.01). Additionally, these patients demonstrated more frequent preoperative narcotic use (87.5% vs 63.2%), longer postoperative narcotic use (39.1 vs 6.0 days) and a higher morphine equivalent dose per prescription (44.7 vs 35.2 dose per day, each p <0.001).
  
  
  CONCLUSIONS
  Postoperative doctor shopping is common among patients with nephrolithiasis who require operative management. Urologists should be aware of available registry data to decrease the likelihood of redundant narcotic prescribing.
authors.affiliation: Departments of Urologic Surgery and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Kappa
authors.affiliation: Departments of Urologic Surgery and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Green
authors.affiliation: Departments of Urologic Surgery and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
authors.affiliation: Departments of Urologic Surgery and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Stanley D
authors.initials: SD
authors.lastname: Herrell
authors.affiliation: Departments of Urologic Surgery and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mitchell
authors.affiliation: Department of Orthopedic Surgery, Florida Orthopaedic Institute, Tampa, Florida.
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Health Care System, Nashville, Tennessee.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Resnick
mesh_terms: D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D061214:Patient Safety; D010820:Physicians; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures / Q000379:methods*
chemical_list: D009294:Narcotics
keywords: kidney; narcotics; nephrolithiasis; patient safety; physicians