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Opioid Use After Colorectal Resection: Identifying Preoperative Risk Factors for Postoperative Use

Published:November 21, 2022DOI:https://doi.org/10.1016/j.jss.2022.10.051

      Highlights

      • This study evaluates preoperative risk factors that may predict postdischarge opioid prescriptions in colorectal resection patients.
      • Study reviewed 1427 colorectal surgeries from January 2013 to December 2020 linked with state-tracked opioid data.
      • Few studies identify patient inherent risk factors for postdischarge opioid prescribed morphine milligram equivalents following colorectal resections.
      • Enhanced recovery pathway suggested perioperative analgesic procedures are not protective of postoperative discharge needs in colorectal surgery.

      Abstract

      Introduction

      Appropriate prescribing practices are imperative to ensure adequate pain control, without excess opioid dispensing across colorectal patients.

      Methods

      National Surgical Quality Improvement Program, Kentucky All Scheduled Prescription Electronic Reporting, and patient charts were queried to complete a retrospective study of elective colorectal resections, performed by a fellowship-trained colorectal surgeon, from January 2013 to December 2020. Opioid use at 14 d and 30 d posthospital discharge converted into morphine milligram equivalents (MMEs) were analyzed and compared across preadmission and inpatient factors.

      Results

      One thousand four hundred twenty seven colorectal surgeries including 56.1% (N = 800) partial colectomy, 24.1% (N = 344) low anterior resection, 8.3% (N = 119) abdominoperineal resection, 8.4% (N = 121) sub/total colectomy, and 3.0% (N = 43) total proctocolectomy. Abdominoperineal resection and sub/total colectomy patients had higher 30-day postdischarge MMEs (P < 0.001, P = 0.041). An operative approach did not affect postdischarge MMEs (P = 0.440). Trans abdominal plane blocks do not predict postdischarge MMEs (0.616). Epidural usage provides a 15% increase in postdischarge MMEs (P = 0.020). Age (P < 0.001), smoking (P < 0.001), chronic obstructive pulmonary disease (P = 0.006, < 0.001), dyspnea (P = 0.001, < 0.001), albumin < 3.5 (P = 0.085, 0.010), disseminated cancer (P = 0.018, 0.001), and preadmission MMEs (P < 0.001) predict elevated 14-day and 30-day postdischarge MMEs.

      Conclusions

      We conclude that perioperative analgesic procedures, as enhanced recovery pathway suggests, are neither predictive nor protective of postoperative discharge MMEs in colorectal surgery. Provider should account for preoperative risk factors when prescribing discharge opioid medications. Furthermore, providers should identify appropriate adjunct procedures to improve discharge opioid prescription stewardship.

      Keywords

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