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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
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Preoperative Opioid Dose and Surgical Outcomes in Colorectal Surgery
Brian D Lo1, George Q Zhang1, Joseph K Canner2
1From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD.
Journal of the American College of Surgeons
|March 15, 2022
Summary
Higher preoperative opioid doses in colectomy patients correlate with increased surgical complications, including anastomotic leaks and readmissions. This highlights the need for caution in prescribing opioids before surgery to improve patient outcomes.
Area of Science:
- Colorectal Surgery
- Anesthesiology
- Public Health
Background:
- The opioid epidemic increases chronic preoperative opioid use in surgical patients.
- Impact of preoperative opioids on surgical outcomes requires further elucidation.
Purpose of the Study:
- To assess the association between preoperative opioid dose and surgical outcomes in colectomy patients.
Main Methods:
- Retrospective analysis of adult colectomy patients (2010-2017) from the IBM MarketScan database.
- Stratification by preoperative opioid dose (Morphine Milligram Equivalents: 0, 1-49, ≥50 MME).
- Multivariable regression analysis to evaluate associations with anastomotic leak and other complications.
Main Results:
- Among 45,515 patients, 1.2% used ≥50 MME preoperatively.
- Higher opioid doses correlated with increased anastomotic leak incidence (p trend = 0.001).
- Dose-response relationship observed: higher MME associated with increased odds of anastomotic leak, lung complications, pneumonia, delirium, and 30-day readmission.
Conclusions:
- Increasing preoperative opioid doses are linked to worse surgical outcomes in colectomy patients.
- Providers should exercise caution with preoperative opioid prescribing.
- Preoperative opioid use is associated with higher 30-day readmission rates.
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