Introduction: Radical cystectomy (RC) is associated with high rates of ileus and bowel complications. There has been increased use of u-opioid receptor antagonists to help combat decreased gastric motility associated with opioid use. However, the relationship between postoperative opioid use and length of stay (LOS) is uncertain. This study was aimed at elucidating the relationship between opioid use in postoperative RC patients and LOS.

Methods: We retrospectively identified any patients who underwent RC for bladder cancer at our institution between January 2009 and December 2019. There were no other inclusion or exclusion criteria. Univariable and multivariable analyses were used to determine the relationship between patient-specific factors associated with increased LOS.

Results: A total of 240 patients were included in the study; 81.3% of our population was male (195/240) with a median age of 70.0 years and median body mass index of 27.3. Most patients had T2 disease (54.4%, 124/228), 37.5% (90/240) patients received neoadjuvant chemotherapy, and ileal conduits were created in 85.4% (205/240) of patients. The median LOS was 10.0 days and the median daily morphine equivalents (MEqs) were 43.13. Nasogastric (NG) was required in 89 patients (37.1%), and TPN was given in 56 patients (23.3%). Univariable linear regression demonstrated that intraoperative transfusion, prior pelvic radiation, ileus, and takeback ORs were all significantly associated with increased LOS (p<0.05). Multivariable regression demonstrated that prior pelvic radiation, higher Clavien grade complication, and daily morphine equivalents had significant correlation and were able to account for 65.2% of the variance in LOS. A one-day increase in LOS was seen with an increase of 13.33 daily MEqs of morphine.

Conclusions: This study demonstrates that prior pelvic radiation, higher Clavien grade during admission, and increased daily MEqs were significantly associated with increased LOS.