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Predictors of Prolonged Opioid Use Following Colectomy.

Adam C Fields1,2, Paul M Cavallaro3, Darin J Correll4

  • 1Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

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Summary
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10.6% of patients undergoing colectomy experienced prolonged opioid use. Prior opioid use, ostomy creation, and higher discharge opioid quantities were key predictors of this outcome.

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Area of Science:

  • Surgical Outcomes
  • Public Health
  • Pharmacology

Background:

  • The United States faces a significant opioid epidemic.
  • Gastrointestinal surgery is a leading contributor to opioid prescribing rates.

Purpose of the Study:

  • To determine the incidence of prolonged opioid use after colectomy.
  • To identify risk factors associated with prolonged opioid use in this patient population.

Main Methods:

  • Retrospective analysis of 1243 patients undergoing colectomy from 2015-2017.
  • Data sourced from the American College of Surgeons National Surgical Quality Improvement Program across 5 institutions.
  • Prolonged opioid use defined as new opioid prescription 90-180 days postoperatively.

Main Results:

  • 10.6% of patients exhibited prolonged opioid use.
  • Independent predictors included prior opioid use (OR 2.6), ostomy creation (OR 2.1), higher discharge opioid quantity (OR 1.9), higher ASA classification (OR 1.7), and hospital readmission (OR 2.0).
  • Complications and readmissions within 30 days were associated with prolonged use.

Conclusions:

  • A significant proportion of colectomy patients develop prolonged opioid use.
  • Identified risk factors can inform targeted preoperative interventions and postoperative monitoring programs.
  • Further research may focus on opioid cessation strategies.