Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts 12 Feasibility of a Non-opioid Pathway Post Ureteroscopy: Joint Analysis from Two Academic Center Mohannad Awad, MD 1 , Mark Assmus, MD 2 , Adrian Berg, MD 1 , Matthew Lee, MD 3 , Luke Hallgarth, MD 1 , Amy Krambeck, MD 4 , Kevan Sternberg, MD 1 1 University of Vermont Medical Center, Burlington, VT, USA; 2 Indiana University, Indaianapolis, IN, USA; 3 Indiana University, Indianapolis, IN, USA; 4 Northwestern University, Chicago, IL, USA Introduction: In an effort to combat the alarming amount of postoperative opioid prescribing in the United States (U.S.), many surgical specialties are implementing pathways to limit the routine use of postoperative opioids with the goal of zero opioid prescribing. We sought to examine the durability of established non-opioid post ureteroscopy (URS) pathways previously implemented at two academic urology centers in the U.S. Materials & Methods: We examined patients who underwent URS at two academic centers utilizing a non-opioid postoperative pathway between November 2016 and March 2020. Primary outcomes evaluated included adverse events (Emergency Department (ED) presentation, and Office phone calls for postoperative genitourinary symptoms) for patients discharged with and without opioids. Secondary outcomes were factors associated with adverse events. Results: In total, 699 patients underwent URS with stent placement. Of these, 652 (89.4%) were dischargedwithout opioids and 74 (10.6%) received opioids postoperatively. Of those discharged without opioids, 484 (77.4%) received non-steroidal anti-inflammatory medications. The majority of patients were prescribed adjunct medications (acetaminophen, phenazopyridine, and/ or tamsulosin) upon discharge. Compared to patients discharged without opioids, patients who were prescribed opioids were more likely to present to the ED (67 (10.7%) vs. 14 (19.9%), p=0.037) and call the clinic postoperatively for genitourinary symptoms (102 (16.3%) vs. 22 (29.7%), p=0.004). In a multivariate analysis, patients prescribed opioids post URS (OR 1.9, 95% CI 1.1 - 3.5, p=0.024) and patients who had an opioid prescription preop (OR 2.2, 95% CI 1.1 - 4.5, p=0.032) were associated with higher odds of calling the clinic for genitourinary symptoms. Older patients (OR 0.98, 95% CI 0.97 - 0.99, p=0.006) were less likely to call the clinic for genitourinary symptoms. Conclusions: The study highlights that almost 90% of patients can be discharged safely without opioids following URS. In our cohort, patients prescribed opioids experienced higher postoperative healthcare interactions (ED visits and office phone calls). We hope our results will encourage other urologists to consider non-opioid pathways post URS. Improved Efficiency of ThuliumVersus Standard HolmiumUreteroscopic Laser Lithotripsy Leads to Large Cost Savings Joshua A. Linscott, MD, PhD 1 , Samuel W. Nowicki, BS 2 , Mitchell H. Nguyen, MD 1 , James R. Ryan, BS 2 , BrianM. Jumper, MD 1 , Johann P. Ingimarsson, MD 1 1 Maine Medical Center, Portland, ME, USA; 2 Tufts University School of Medicine, Boston, MA, USA Introduction: Nephrolithiasis prevalence approaches 10% in the United States with an almost $5 billion/year associated cost of care. As laser lithotripsy is one of the most common urologic procedures, small cost savings per case can have a large financial impact. Recently, the FDA approved thulium fiber laser (TFL) lithotripsy. This technology decreased our average ureteroscopic lithotripsy case time for comparable stones when compared to a standard 100W holmium laser (Hol:YAG). Here, we perform a cost benefit analysis to show projected cost savings at our institution. Materials & Methods: Capital cost for Olympus SOLTIVE™ SuperPulsed Laser systemwas obtained. Price of individual Hol:YAG and TFLfibers were compared. Direct and indirect operating rooms costs per min when using laser at our institution in 2020 were calculated by the financial department. TFL was not introduced until late October and therefore weighted Hol:YAG fiber cost contribution in direct cost calculations was also considered. Indirect costs were assumed to be equal for Hol:YAG and TFL lithotripsy. Average operative times for each modality were determined. Expected annual cost savings were calculated as follows: Time saved (min/case) x Direct OR cost ($/min) x Cases/year = Annual cost saving ($/year). Results: Initial capital costs for 2 SOLTIVE SuperPulsed laser systems based on list price was $350,000. Individual TFLs cost $319.50 vs. $450.00 for holmium fibers. Direct operating room costs for the facility were calculated at $33.82/min, which includes a blended average of Hol:YAG and TFL fiber costs, heavily weighted to Hol:YAG. Average operation time with TFL was 13 min less than with Hol:YAG, saving $440/case. Including laser fiber cost savings not fully accounted for in the calculated direct cost/min raises estimated savings to as high as $570/case. Annually ~670 cases are performed at our institution, giving a range of $294,800 to $381,900 savings per year. Conclusions: Switching from standard Hol:YAG to TFL lithotripsy reduced our operative time significantly, leading to large cost savings ($440/case). TFLs are $150.50 less expensive than Hol:YAG fibers. Together, yearly cost savings are estimated to be $294,000-$381,900. We conservatively expect to cover TFL capital expenditure for 2 laser systems within five fiscal quarters. 11 Scientific Session II: Stones I 7