To explore whether post-radical prostatectomy (RP) opioid prescription is associated with hospital readmission, given that this may represent a potential means of reducing unplanned health service utilization.

The Michigan Urological Surgery Improvement Collaborative registry was queried for patients undergoing RP between May 2018 and October 2024 who completed a questionnaire on number of post-RP opioid pills prescribed. Multivariable models were constructed to evaluate the relationship between either (1) the number of pills prescribed or (2) the provider's “default” prescribing practice and hospital readmissions.

Of 2656 patients with opioid prescription data, 77 were readmitted (rate: 2.9%). Unadjusted readmission rate by opioid prescription count was 2.1% for those receiving no pills, 3.0% for 1-6 pills, and 4.2% for > 6 pills. Multivariable models demonstrated a significant association of opioid prescription (overall P = .041; 0 pills [vs. > 6 pills]: odds ratio [OR] 0.45, 95% confidence interval [CI] 0.24-0.84, P = .012) and provider “default” prescribing practice (after switch to “opioid-free” [vs. before]: OR 0.53, 95% CI 0.29-1.00, exact P = .0495) with readmission.

Omission of post-RP opioid prescription is significantly associated with lower odds of readmission; a change in prescribing habits to “opioid-free” is associated with a decrease in readmission rate. Post-RP opioid prescription is an actionable target in the reduction of unplanned health service utilization.