A retrospective review: Patient-reported preoperative prescription opioid, sedative, or antidepressant use is associated with worse outcomes in colorectal surgery

Tong Gan, Nicholas A. Jackson, Jennifer T. Castle, Daniel L. Davenport, Doug R. Oyler, Laura M. Ebbitt, B. Mark Evers, Avinash S. Bhakta

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


BACKGROUND: Prescription opioid, sedative, and antidepressant use has been on the rise. The effect of these medications on outcomes in colorectal surgery has not been established. OBJECTIVE: This study aimed to evaluate the impact of preoperative prescription opioid, sedative, and antidepressant use on postoperative outcomes following colorectal surgery. DESIGN: This study was a retrospective database and medical record review. SETTINGS: This study was conducted at University of Kentucky utilizing the local American College of Surgeons National Surgical Quality Improvement Project database. PATIENTS: All patients ≥18 years of age who underwent colorectal resection for all indications, excluding trauma, between January 1, 2013, and December 31, 2016, were included. MAIN OUTCOME MEASURES: The primary outcomes measured were the rates of 30-day postoperative morbidity and mortality. RESULTS: Of 1201 patients, 30.2% used opioids, 18.4% used sedatives, and 28.3% used antidepressants preoperatively. Users of any medication class had higher ASA classification, rates of dyspnea, and severe chronic obstructive pulmonary disease than nonusers. Opioid users also had higher rates of ostomy creation, contaminated wound classification, prolonged operation time, and postoperative transfusion. Postoperatively, patients had higher rates of intra-abdominal infection (opioids: 21.5% vs 15.2%, p = 0.009; sedatives: 23.1% vs 15.7%, p = 0.01; antidepressants: 22.4% vs 15.0%, p = 0.003) and respiratory failure (opioids: 11.0% vs 6.3%, p = 0.007; sedatives: 12.2% vs 6.7%, p = 0.008; antidepressants: 10.9% vs 6.5%, p = 0.02). Reported opioid or sedative users had a prolonged hospital length of stay of 2 days (p < 0.001) compared with nonusers. After adjustment for all predictors of poor outcome, opioid and sedative use was associated with increased 30-day morbidity and mortality following colorectal procedures (OR, 1.43; 95% CI, 1.07-1.91 and OR, 1.48; 95% CI, 1.05-2.08). LIMITATIONS: This study was a retrospective review and a single-institution study, and it had unmeasured confounders. CONCLUSIONS: We identified that patient-reported prescription opioid and sedative use is associated with higher 30-day composite adverse outcomes in colorectal resections, highlighting the need for the evaluation of opioid and sedative use as a component of the preoperative risk stratification. See Video Abstract at http://links.lww.com/DCR/B226.

Original languageEnglish
Pages (from-to)965-973
Number of pages9
JournalDiseases of the Colon and Rectum
Issue number7
StatePublished - Jul 1 2020

Bibliographical note

Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.


  • Antidepressants
  • Colorectal surgery outcomes
  • Opioids
  • Sedatives

ASJC Scopus subject areas

  • General Medicine


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