Discharge Opioid Prescription After Outpatient Urologic Surgery Is Associated With Increased Risk of Opioid Refills: A Retrospective Cohort Study.

OBJECTIVE: To examine the impact of discharge opioid prescription on opioid refills after outpatient urologic surgery. There is currently little guidance on opioid prescribing for outpatient urologic surgery. Surgeons often prescribe opioids "just in case" using their judgment. METHODS: This retrospective single-institution cohort study included 12,422 adult patients who underwent outpatient urologic surgery between January 2017 and December 2024 with a postoperative length of stay <12 hours. The primary exposure was any opioid prescribed at discharge. Covariates included opioid-naïve status, preoperative benzodiazepine and/or marijuana use, procedure type, intraoperative and Post Anesthesia Care Unit (PACU) opioids administered, pain score before discharge, non-opioid analgesics prescribed at discharge, and demographics (age, sex, race, and ethnicity). The primary outcomes were opioid refills at 1-30, 31-60, and 61-90 days after surgery. RESULTS: Among the 12,422 patients, 4,264 (34.3%) received an opioid prescription at discharge. Patients discharged with opioids had higher opioid refill rates after surgery, regardless of opioid-naïve status, PACU opioid usage, pain score before discharge, or procedure type. When all other perioperative factors were controlled, discharge opioid prescriptions were associated with increased odds of opioid refills at 1-30 (aOR 2.19, 95% CI 1.87-2.56), 31-60 (aOR 1.89, 95% CI 1.57-2.28), and 61-90 (aOR 1.75, 95% CI 1.44-2.13) days after surgery. CONCLUSIONS: After outpatient urologic surgery, discharge opioid prescription is independently associated with increased odds of postoperative opioid refills. These findings suggest that providers could avoid routine or "just-in-case" opioid prescribing after outpatient urologic procedures, particularly in patients without demonstrated postoperative analgesic need.