title: Predictors of narcotic use after percutaneous nephrolithotomy.
abstract: BACKGROUND
  Percutaneous nephrolithotomy (PCNL) is associated with significant variability in postoperative pain and subsequent narcotic use. The purpose of this study was to determine the factors associated with high narcotic use following PCNL.
  
  
  METHODS
  A single-center retrospective review of patients undergoing initial PCNL between 2004 and 2014 was performed. Preoperative, intraoperative and postoperative factors associated with postoperative narcotic usage were analyzed. The primary outcome variable was mean narcotic usage, standardized to intravenous morphine-equivalents. Patients in the lowest 75th percentile were compared to those in the highest 25th percentile. Univariate and multivariate statistical analyses were performed, with p < 0.05 considered significant.
  
  
  RESULTS
  When the 243 patients were compared from lowest to highest quartile, total narcotic use during the first 48 hour period was 2.3, 8.4, 15.6, and 41.7 mg of morphine-equivalents. On univariate analysis, predictors of high narcotic use included age 20-39 (p < 0.001), preoperative narcotic use (p < 0.001), presence of a postoperative complication (p = 0.044), and high stone burden (p = 0.002). Age < 20 (p < 0.001) and > 60 years (p = 0.014) were associated with low narcotic use. On multivariate analysis, age 20-39 (OR 6.87, 95% CI 2.22-21.23, p = 0.001), male gender (OR 2.47, CI 1.05-5.81, p = 0.037), and preoperative narcotic use (OR 3.27, CI 1.41-7.60, p = 0.006) were associated with higher opioid requirement.
  
  
  CONCLUSIONS
  Patients who were aged 20-39, males, and those with prior narcotic exposure used the highest doses of narcotics postoperatively. Knowledge of the factors predictive of high narcotic usage may allow better preoperative management of patient expectations and more effective postoperative care to prevent the complications of high narcotic usage.
authors.affiliation: Department of Urology, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: Nazih
authors.initials: N
authors.lastname: Khater
authors.forename: Mohamed
authors.initials: M
authors.lastname: Keheila
authors.forename: Michelle
authors.initials: M
authors.lastname: Lightfoot
authors.forename: Jim
authors.initials: J
authors.lastname: Shen
authors.forename: Samuel
authors.initials: S
authors.lastname: Abourbih
authors.forename: Muhannad
authors.initials: M
authors.lastname: Alsyouf
authors.forename: Roger
authors.initials: R
authors.lastname: Li
authors.forename: D Duane
authors.initials: DD
authors.lastname: Baldwin
mesh_terms: D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D057234:Preoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid