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

Levy, Brittany E.; Castle, Jennifer T.; Ebbitt, Laura M.; Kennon, Caleb; McAtee, Erin; Davenport, Daniel L.; Evers, B. Mark; Bhakta, Avinash

doi:10.1016/j.jss.2022.10.051

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…3). This is a finding that has been replicated by other groups both within 10,[22][23][24] and outside of colorectal surgery. [25][26][27][28] Explanatory mechanisms for this finding have included age-related blunting of peripheral sensory nerve conduction, reduction in pharmacokinetic opioid clearance, and lower average anxiety combined with higher average psychological resiliency in older adults.…”

Section: Discussionsupporting

confidence: 57%

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Vu,

Franko,

Buzadzhi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The ongoing opioid crisis demands an investigation into the factors driving postoperative opioid use. Ambulatory robotic colectomies are an emerging concept in colorectal surgery, but concerns persist surrounding adequate pain control for these patients who are discharged very early. We sought to identify key factors affecting recovery room opioid use (ROU) and additional outpatient opioid prescriptions (AOP) after ambulatory robotic colectomies. Methods: This was a single-institution retrospective review of ambulatory robotic colon resections performed between 2019 and 2022. Patients were included if they discharged on the same day (SDD) or postoperative day 1 (POD1). Outcomes of interest included ROU [measured in parenteral morphine milligram equivalents (MMEs)], AOP (written between PODs 2 to 7), postoperative emergency department presentations, and readmissions. Results: Two hundred nineteen cases were examined, 48 of which underwent SDD. The mean ROU was 29.4 MME, and 8.7% of patients required AOP. Between SDD and POD1 patients, there were no differences in postoperative emergency department presentations, readmissions, recovery opioid use, or additional outpatient opioid scripts. Older age was associated with a lower ROU (−0.54 MME for each additional year). Older age, a higher body mass index, and right-sided colectomies were also more likely to use zero ROU. Readmissions were strongly associated with lower ROU. Among SDD patients, lower ROU was also associated with higher rates of AOP. Conclusion: Ambulatory robotic colectomies and SDD can be performed with low opioid use and readmission rates. Notably, we found an association between low ROU and more readmission, and, in some cases, higher AOP. This suggests that adequate pain control during the postoperative recovery phase is a crucial component of reducing these negative outcomes.

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Section: Discussionsupporting

confidence: 57%

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Vu,

Franko,

Buzadzhi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Firstly, preoperative optimisation and early recovery bundles of care have been shown to improve overall outcome, 156 including, potentially, analgesic use 157 . Secondly, recent evidence has underlined the considerable interindividual difference in pain susceptibility, 158 which is influenced by readily identifiable risk factors such as preoperative opioid use, 159 and also biopsychosocial factors that require specific testing to uncover 160 . Thirdly, conversion of any laparoscopic abdominal surgery to open surgery will increase the complexity of postoperative pain management, increasing the need for more intense analgesic methods, such as multimodal analgesia, wound infiltration, 161 or regional anaesthesia 64 .…”

Section: Discussionmentioning

confidence: 99%

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Lirk,

Badaoui,

Stuempflen

et al. 2024

European Journal of Anaesthesiology

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Colorectal cancer is the second most common cancer diagnosed in women and third most common in men. Laparoscopic resection has become the standard surgical technique worldwide given its notable benefits, mainly the shorter length of stay and less postoperative pain. The aim of this systematic review was to evaluate the current literature on postoperative pain management following laparoscopic colorectal surgery and update previous procedure-specific pain management recommendations. The primary outcomes were postoperative pain scores and opioid requirements. We also considered study quality, clinical relevance of trial design, and a comprehensive risk–benefit assessment of the analgesic intervention. We performed a literature search to identify randomised controlled studies (RCTs) published before January 2022. Seventy-two studies were included in the present analysis. Through the established PROSPECT process, we recommend basic analgesia (paracetamol for rectal surgery, and paracetamol with either a nonsteroidal anti-inflammatory drug or cyclo-oxygenase-2-specific inhibitor for colonic surgery) and wound infiltration as first-line interventions. No consensus could be achieved either for the use of intrathecal morphine or intravenous lidocaine; no recommendation can be made for these interventions. However, intravenous lidocaine may be considered when basic analgesia cannot be provided.

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“…Currently, the minimally invasive approaches for ovarian cystectomy are vaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single-site surgery (TU-LESS) ( 12 , 13 ). Meanwhile, enhanced recovery after surgery (ERAS) has developed rapidly, which optimizes the clinical path of perioperative treatment, reduces the stress response of surgical trauma, shortens hospital stay, and promotes rapid recovery of patients ( 14 – 16 ). Based on the ERAS concept, the day-care procedure further optimizes the disease diagnosis and treatment process, which allows patients to be admitted, operated, and discharged within 24 h ( 17 – 19 ).…”

Section: Introductionmentioning

confidence: 99%

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

Xie

Huang

et al. 2023

Front. Med.

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IntroductionAlthough previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and better concealment of surgical incisions, which aligns with the concept of the day-care procedure, this approach poses a greater risk of damaging adjacent organs (i. e., rectum and bladder) due to its anatomical specificity. Moreover, the day-care procedure may lead to relatively less preoperative evaluation and postoperative care. Hence, it is necessary to explore the safety and effectiveness of vNOTES for ovarian cystectomy in the day-care procedure, to provide a theoretical basis for the wider development of vNOTES surgery.Materials and methodsThis retrospective study included 131 patients at our hospital who underwent ovarian cystectomy from September 2021 to October 2022. Based on the surgical approach, patients were classified into transumbilical laparoendoscopic single-site surgery (LESS) and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and 1-month postoperatively.ResultsVaginal natural orifice transluminal endoscopic surgery has less postoperative exhaust time, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use, with higher surgical conversion incidence. Multiple linear regression analysis showed that the surgical conversion, chocolate cyst, bilateral cyst, and pelvic adhesion increased the operation duration by ~43 (95% CI: 10.309, 68.152, p < 0.001), 15 (95% CI: 6.342, 45.961, p = 0.036), 10 (95% CI: 3.07, 40.166, p = 0.019), and 8 (95% CI: 4.555, 26.779, p = 0.035) min, respectively. Interestingly, vNOTES decreased the operation duration by ~8.5 min (95% CI: −18.313, −2.699, p = 0.033).ConclusionVaginal natural orifice transluminal endoscopic surgery was equally safe and effective for ovarian cystectomy compared to LESS. vNOTES aligned with the concept of the day-care procedure due to its reduced postoperative pain, shorter exhaust time, and absence of scarring. However, surgeons should conduct a comprehensive preoperative evaluation and exclude patients suspected to have severe pelvic adhesions.

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

Cited by 3 publications

References 24 publications

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

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