New persistent opioid use following major surgery is well documented [1]. Within urology specifically, patients undergoing a radical cystectomy for bladder cancer had nearly a 10% rate of new persistent opioid use. Risks of persistent use include any opioid prescription and larger morphine equivalents prescribed [2,3]. These data have contributed to national guidelines as well as recommendations from working groups within the American Urologic Association to limit opioid prescribing [4].

Several studies have evaluated patient risk factors contributing to new persistent use; however these investigations often exclude high-risk populations [2,3,5]. A common exclusion is patients with an opioid prescription prior to surgery. This population is likely heterogenous, including chronic users as well as those who receive a prescription for a short-course medication. In addition, prior work has focused on private insurance databases [2,3]; however, patients with public insurance may be at higher risk for overdose events and opioid dependence following surgery [5]. Finally, hospital and physician characteristics leading to persistent use have not been studied. New opioid prescription during nonsurgical admissions varied in Medicare beneficiaries based on hospital size and characteristics, however these hospital variables have not been evaluated following urologic surgery [6]. Further study may provide more complete knowledge on factors influencing persistent post-operative opioid use to allow for early intervention.

This study evaluates opioid use in patients undergoing radical cystectomy for bladder cancer using the surveillance, epidemiology and end results (SEER)-Medicare database and includes opioid-naïve as well as non-opioid naïve patients. The aim of this investigation is to further describe this non-opioid naïve population and to identify characteristics that predict persistent opioid use. This evaluation will further inform efforts to limit persistent opioid use following major urologic surgery.