Real-Time Measurement of Patient Reported Outcomes and Opioid Use Following Urologic Procedures using Automated Text Messaging

Abstract

Objective: To evaluate opioid consumption and patient-reported pain intensity following urologic procedures.

Methods: Adult patients were consented following a urologic procedure, and data was collected through postoperative day 28 in a large tertiary care academic health system. An automated text messaging platform was used to collect patient reported pain intensity, ability to manage pain, and opioid use measured in oxycodone 5mg tablet equivalents. Outcomes were weighted based on the inverse probability of response to yield representative estimates.

Results: One thousand and fifteen (51.8%) patients responded to the text-message survey. The median number of pills prescribed was 10 (IQR 6-10), and the median number of pills taken was 2 (IQR 0-6). By postoperative day 7, the median tablets taken overall was 0. Over the study period, 60.1% (6566) of all tablets prescribed were left unused, and 38.4% of patients did not use any of the prescribed opioids. Across urologic procedures, 6 tablets would accommodate the 75^th percentile of patient-reported use, with the exception of major open procedures.

Conclusion: In this study utilizing real-time measurement of opioid use and pain levels with text messaging, there was evidence of dramatic over-prescription of opioids relative to use and pain levels. Patient-reported data, collected via text messaging, can support clinicians and policy leaders in forming national guidelines on evidence-based best practices, personalizing prescriptions and guide shared decision making to decrease opioid excess.