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Clinician training level impacts prescribing practices for the conservative management of acute renal colic: a contemporary update

  • Urology - Original Paper
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Abstract

Purpose

Given the current and increasing awareness of the opioid crisis, this study aimed to characterise the types of analgesic prescription for conservatively managed renal colic.

Methods

This was a retrospective cohort study of consecutive patients presenting to the Emergency Department (ED) in 2014–2019. Patients were included if they had radiographically confirmed obstructing calculus, managed conservatively without intervention, and were given a prescription for analgesia on discharge. Patient demographics were recorded and analysed. Opioid, non-opioid, and alpha-blocker medications were compared according to patient and disease parameters, and clinician training. Oral morphine equivalents (OMEs) were used to compare prescribed quantities. Subgroup analyses of stone size and location were performed.

Results

Our analysis included 1761 patients with confirmed renal colic: median age of 50 years (16–96). Altogether, 88% of included patients were prescribed opioids on discharge, while only 68% were prescribed non-opioids (p < 0.001). Oxycodone immediate release was the most frequently prescribed analgesic. Logistic regression modelling controlling for patient and disease characteristics significantly predicted more non-opioid (p < 0.001) and alpha-blocker (p = 0.037) prescription with clinician training < 3 years. Linear regression modelling demonstrated that clinicians training < 3 years predicted lower OMEs per prescription compared to clinicians with ≥ 3 years of training (p = 0.001). Subgroup analyses supported similar predictions with training.

Conclusions

Prescribing patterns are associated with different clinician experience levels. However, a substantial amount of opioids are still given overall on patient discharge regardless of the clinician experience. Educational interventions aimed at reducing the opioid prescription rate and quantities may be considered for clinicians of all training levels.

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Data availability

Data will not be available online but will be shared upon request.

Abbreviations

AKI:

Acute kidney injury

CI:

Confidence interval

ED:

Emergency department

IR:

Immediate release

KDIGO:

Kidney Disease Improving Global Outcomes

NSAID:

Non-steroidal anti-inflammatory drug

OME:

Oral morphine equivalent

OR:

Odds ratio

PUJ:

Pelviureteric junction

SR:

Sustained release

VUJ:

Vesicoureteric junction

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Funding

The authors declare no funding was used to support this study.

Author information

Author notes

  1. Liang G. Qu and Garson Chan contributed equally to the work.

Authors and Affiliations

  1. Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia

    Liang G. Qu, Garson Chan & Johan Gani

  2. Department of Surgery, University of Melbourne, Melbourne, VIC, Australia

    Liang G. Qu, Garson Chan & Johan Gani

  3. Department of Surgery, University of Saskatchewan, Saskatchewan, Canada

    Garson Chan

  4. Department of Urology, Western Health, Footscray, VIC, Australia

    Johan Gani

Authors
  1. Liang G. Qu
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  2. Garson Chan
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  3. Johan Gani
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Contributions

LGQ, GC and JG: conceived the study; LGQ: performed data collection; LGQ and GC: performed data analysis; LGQ, GC and JG: drafted the manuscript. All authors contributed substantially to its revision. LGQ takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Liang G. Qu.

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Qu, L.G., Chan, G. & Gani, J. Clinician training level impacts prescribing practices for the conservative management of acute renal colic: a contemporary update. Int Urol Nephrol 53, 661–667 (2021). https://doi.org/10.1007/s11255-020-02686-6

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