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Use of Narcotic medications after surgical treatment for organ confined prostate cancer
Aaron C. Weinberg, BS1, , Xiangmei Gu, MS2, Stuart Lipsitz, PhD2, Marcos P. Freire, MD, Lei Yin, MD1, Sergey K. Kravichick, MD2, 1Jim C. Hu, MD, MPH1.
1Division of Urologic Surgery Brigham and Women’s Hospital, Boston, MA, 2Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA

Background: Minimally invasive radical prostatectomy (MIRP) is considered a less invasive procedure when compared to open radical prostatectomy, perineal (PRP) and retropubic (RRP), and therefore is expected to have less morbidity, pain and analgesic consumption. We performed a population-based study during 2003-2006 to determine utilization patterns, duration of therapy and cost for localized prostate cancer treatment.
Methods: We identified 38,958 men from the MarketScan Medstat administrative dataset who underwent definitive treatment for localized prostate cancer during 2003-06 and selected the 13,442 men who filled a narcotic prescription within 3 days of hospital discharge. We assessed utilization and refill rates for Narcotic medications in the postoperative period, up to 3 months following surgery, by identifying National Drug Classification codes. The duration of treatment, refill pattern, narcotic strength (morphine equivalent) and cost per week associated with each surgical approach, was analyzed.
Results: Patients undergoing MIRP had less additional refills of narcotic medications, at all intervals examined, than those who underwent open surgery (p<0.001). These patients also used their medication for less days (MIRP: 8 vs. PRP: 10.7 vs. RRP: 8.75) (p<0.001), and required less morphine equivalents (MIRP: 395.4 vs. PRP: 465.7 vs. RRP 415.3) (p<0.001) for their pain and discomfort. Additionally the cost per week was less for MIRP then for open surgeries (MIRP: $14.8 vs. PRP: $19.5 vs. RRP $17) (p<0.001.) While open surgery consisted of both PRP and RRP; RRP had less additional refills, days supplied morphine equivalents and a lower weekly cost.
Conclusions: Men undergoing minimally invasive surgical procedures for the treatment of prostate cancer use less narcotic medications and lower morphine equivalents resulting in a reduced cost per week of analgesic treatment. The influence of pre-operative chronic conditions, patient expectation and prostate cancer treatment selection on our results cannot be determined.
Narcotic usage after definitive surgery for localized prostate cancer.

VariableCategoryMIRPPRPRRPP_value
(N=2888)(N=579)(N=9975)
RefillOriginal Prescription2323(80.4%)326(56.3%)7098(71.4%)<0.001
First Refill343(11.9%)151(26.1%)1807(18.2%)
Second Refill116(4.0%)44(7.6%)580(5.8%)
3rd or more Refill106(3.7%)58(10.0%)450(4.5%)
Day suppliedPost_opMean810.78.7<0.001
Median565
StrengthPost_opMean395.4465.7415.3<0.001
Median200250200
Cost ($)Post_opMean14.819.517<0.001
Median81010

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