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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Article info
Publication history
Published online: November 21, 2022
Accepted:
October 17,
2022
Received in revised form:
September 30,
2022
Received:
May 24,
2022
Identification
Copyright
Published by Elsevier Inc.
