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Lo BD, Zhang GQ, Canner JK, Stem M, Taylor JP, Atallah C, Efron JE, Safar B. Preoperative Opioid Dose and Surgical Outcomes in Colorectal Surgery. J Am Coll Surg 2022; 234:428-435. [PMID: 35290261 DOI: 10.1097/xcs.0000000000000109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Brian D Lo
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - George Q Zhang
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Department of Surgery (Canner), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miloslawa Stem
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - James P Taylor
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chady Atallah
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan E Efron
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bashar Safar
- From the Colorectal Research Unit, Department of Surgery (Lo, Zhang, Stem, Taylor, Atallah, Efron, Safar), The Johns Hopkins University School of Medicine, Baltimore, MD
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