Preventing Excess Narcotic Prescriptions in New Robotic Surgery Discharges: The PENN Prospective Cohort Quality Improvement Initiative.

To reduce the amount of opioids prescribed at discharge after robotic surgery, we hypothesized that the majority patients do not require opioids for pain control after robotic urologic oncologic procedures.This prospective study aimed to reduce opioids prescribed at discharge after robot-assisted radical prostatectomy (RARP), robot-assisted radical nephrectomy (RARN) and robot-assisted partial nephrectomy (RAPN). Prior to 9/2018, 100% of patients were discharged on varying amounts of oxycodone (range: 75-337.5 oral morphine milligram equivalents [MME]). We implemented a standardized non-opioid analgesia pathway with escalation options (Figure 1). To assess the safety of our approach, we analyzed pain scores, telephone encounters and ED visits in our cohort.Our cohort (n=170) consisted of patients undergoing RARP (n=87), RARN (n=25), RAPN (n=58) between 9/2018-1/2019. Overall, 67.7% were discharged without opioids, 24.4% with ten pills of tramadol (50 MME) and 8.2% with ten pills of oxycodone (75 MME). On multivariable analysis, older age (OR: 0.961, 95% CI: 0.923-0.995, p=0.026) was associated with lower odds of needing opioids at discharge. There was no difference in pain scores at the post-operative outpatient visit (p=0.66) or postoperative telephone encounters (p=0.45) between those discharged with and without opioids.The majority of robotic surgery patients do not require opioids upon discharge. Implementation of a simple, standardized, non-opioid protocol resulted in a dramatic reduction in the amount of opioids prescribed in our patient population. An escalation protocol allows for a patient centered approach to reduce narcotic prescribing while still addressing surgical pain.