Preoperative Opioid Dose and Surgical Outcomes in Colorectal Surgery

Abstract

BACKGROUND: The worsening opioid epidemic has led to an increased number of surgical patients with chronic preoperative opioid use. However, the impact of opioids on perioperative outcomes has yet to be fully elucidated. The purpose of this study was to assess the association between preoperative opioid dose and surgical outcomes among colectomy patients. METHODS: Adult colectomy patients in the IBM MarketScan database (2010–2017) were stratified based on preoperative opioid dose, calculated as the average opioid dose in morphine milligram equivalents (MME) in the 90 days prior to surgery: 0 MME, 1 to 49 MME, and 50 or more MME. The association between preoperative opioid dose and anastomotic leak, the primary outcome of interest, as well as other postoperative complications, was assessed using multivariable regression. RESULTS: Among 45,515 adult colectomy patients, 71.4% did not use opioids (0 MME), 27.4% had an opioid dose between 1 and 49 MME, and 1.2% had an opioid dose at or above 50 MME. Patients with preoperative opioid use exhibited a higher incidence of anastomotic leak (0 MME: 4.8%, 1–49 MME: 5.5%, ≥50 MME: 8.3%; p trend = 0.001). Multivariable analysis demonstrated a dose–response relationship between preoperative opioids and surgical outcomes, as the odds of anastomotic leak worsened with increasing opioid dose (1–49 MME: OR 1.19, 95% CI 1.08–1.31, p < 0.001; ≥50 MME: OR 1.64, 95% CI 1.20–2.24, p = 0.002). Similar dose–response relationships were seen after risk-adjustment for lung complications, pneumonia, delirium, and 30-day readmission (p < 0.05 for all). CONCLUSIONS: Providers should exercise caution when prescribing opioids preoperatively, as increasing doses of preoperative opioids were associated with worse surgical outcomes and higher 30-day readmission among adult colectomy patients.

Analysis of postoperative pulmonary complications after gastrectomy for gastric cancer: development and validation of a nomogram

“…Sayal et al (35) demonstrated that patients with opioid use disorders were at increased risk for PPCs. The increasing dose of opioids might lead to worse surgical outcomes and higher lung complications (36). There was little difference in the dose of fentanyl between PPCs group and non-PPCs group in our cohort study, but the dose of oxycodone was significantly different.…”

Prevalence of cannabis use disorder and perioperative outcomes in adult colectomy patients: A propensity score‐matched analysis

“…This theory has been extensively studied in the literature with mixed results regarding its validity 24,25 . Nevertheless, this remains an important consideration given the known risks of preoperative opioid use in colorectal surgery 26,27 . Recognizing how these modifiable risk factors may be associated with clinical outcomes will be essential to optimizing patient outcomes in the future.…”

Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians

“…Despite this, as many as one out of four patients scheduled for surgery in the USA uses opioids preoperatively,123 with the prevalence rising to 50% or greater in patients undergoing orthopedic or spine surgeries 120 123. Recent retrospective analyses have utilized a dose of 50 morphine milligram equivalents per day (MME/day) as a categorical benchmark for indicating an elevated perioperative opioid requirement,124 125 but it has not been established whether there is a perioperative MME/day threshold below which a patient’s postsurgical risks are equivalent to that of an opioid-naive patient. Animal and human studies indicate that very low doses of opioids can induce hyperalgesia 126 127…”

“…Presurgical opioid exposure is associated with an increased risk of PPSP,45 108 possibly via opioid-induced hyperalgesia (OIH), increased N-methyl-D-aspartate (NMDA) receptor activation, low baseline pain thresholds or modulatory changes in medullary spinal pathways 128 129. Although there may be a dose–response relationship between preoperative120 124 125 and intraoperative130 opioid doses and adverse postsurgical outcomes, the evidence remains limited 113. A recent retrospective cohort analysis of insurance claims data comprizing over 57 000 patients did not find clinically significant differences in postsurgical opioid utilization in terms of prescriptions filled or dosages in MME/day regardless of whether patients had stable, increasing or decreasing trajectories of presurgical opioid utilization 131.…”