Investig Clin Urol.  2021 Jan;62(1):56-64. 10.4111/icu.20200194.

Recovery from minimally invasive vs. open surgery in kidney cancer patients: Opioid use and workplace absenteeism

• Krimphove MJ
• Reese SW
• Chen X
• Marchese M
• Pucheril D
• Cone E
• Chou W
• Tully KH
• Kibel AS
• Urman RD
• Chang SL
• Kluth LA
• Dasgupta P
• Trinh QD

• KMID: 2509851
• DOI: http://doi.org/10.4111/icu.20200194

Abstract

Purpose
Does surgical approach (minimally invasive vs. open) and type (radical vs. partial nephrectomy) affects opioid use and workplace absenteeism.
Materials and Methods
Retrospective multivariable regression analysis of 2,646 opioid-naïve patients between 18 and 64 undergoing radical or partial nephrectomy via either a minimally invasive vs. open approach for kidney cancer in the United States between 2012 and 2017 drawn from the IBM Watson Health Database was performed. Outcomes included: (1) opioid use in opioidnaïve patients as measured by opioid prescriptions in the post-operative setting at early, intermediate and prolonged time periods and (2) workplace absenteeism after surgery.
Results
Patients undergoing minimally invasive surgery had a lower odds of opioid use in the early and intermediate post-operative periods (early: odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62–0.97; p=0.02, intermediate: OR, 0.60; 95% CI, 0.48–0.75; p<0.01), but not in the prolonged setting (prolonged: OR, 1.00; 95% CI, 0.75–1.34; p=0.98) and had earlier return to work (minimally invasive vs. open: -10.53 days; 95% CI, -17.79 to -3.26; p<0.01). Controlling for approach, patient undergoing partial nephrectomy had lower rates of opioid use across all time periods examined and returned to work earlier than patients undergoing radical nephrectomy (partial vs. radical: -14.41 days; 95% CI, -21.22 to -7.60; p<0.01).
Conclusions
Patients undergoing various forms of surgery for kidney cancer had lower rates of peri-operative opioid use, fewer days of workplace absenteeism, but no difference in long-term rates of opioid use in patients undergoing minimally invasive as compared to open surgery.

Keyword

Absenteeism; Kidney neoplasm; Minimally invasive surgical procedures; Nephrectomy; Opioids