Long-Term Opioid Use After Colon and Rectal Surgery

Area of Science:

• Colorectal Surgery
• Pain Management
• Public Health

Background:

• The United States faces a significant opioid epidemic.
• Enhanced Recovery After Surgery (ERAS) pathways aim to minimize perioperative opioid consumption.
• Opioid-naïve patients undergoing colorectal surgery are the focus for evaluating long-term opioid use.

Purpose of the Study:

• To determine if standardized, nonnarcotic ERAS protocols decrease long-term opioid use in opioid-naïve patients after colorectal surgery.
• To analyze trends in persistent opioid use postoperatively.

Main Methods:

• Retrospective cohort study of 1363 opioid-naïve patients from 2017-2020.
• Data sourced from the American College of Surgeons National Surgical Quality Improvement Program and Epic Systems.
• Standardized ERAS protocols were implemented across five institutions.

Main Results:

• A stepwise reduction in long-term opioid use was observed from 2017 to 2020.
• Persistent opioid use at 6 and 12 months decreased significantly over the study period (P < 0.01).
• For instance, 16% and 11% of patients used opioids at 6 and 12 months in 2017-2018, versus 11% and 4% in 2019-2020.

Conclusions:

• Standardizing opioid-sparing strategies within ERAS pathways effectively reduced long-term opioid use.
• A small percentage of opioid-naïve patients may still experience persistent opioid use one year post-surgery.
• The findings support the use of nonnarcotic ERAS protocols to combat the opioid crisis in surgical settings.