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

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

doi:10.1016/j.jss.2022.10.051

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

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

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Introduction: Appropriate prescribing practices are imperative to ensure adequate pain control, without excess opioid dispensing across colorectal patients. Methods: National Surgical Quality Improvement Program, Kentucky All Scheduled Prescription Electronic Reporting, and patient charts were queried to complete a retrospective study of elective colorectal resections, performed by a fellowship-trained colorectal surgeon, from January 2013 to December 2020. Opioid use at 14 d and 30 d posthospital discharge converted into morphine milligram equivalents (MMEs) were analyzed and compared across preadmission and inpatient factors. Results: One thousand four hundred twenty seven colorectal surgeries including 56.1% (N = 800) partial colectomy, 24.1% (N = 344) low anterior resection, 8.3% (N = 119) abdominoperineal resection, 8.4% (N = 121) sub/total colectomy, and 3.0% (N = 43) total proctocolectomy. Abdominoperineal resection and sub/total colectomy patients had higher 30-day postdischarge MMEs (P < 0.001, P = 0.041). An operative approach did not affect postdischarge MMEs (P = 0.440). Trans abdominal plane blocks do not predict postdischarge MMEs (0.616). Epidural usage provides a 15% increase in postdischarge MMEs (P = 0.020). Age (P < 0.001), smoking (P < 0.001), chronic obstructive pulmonary disease (P = 0.006, < 0.001), dyspnea (P = 0.001, < 0.001), albumin < 3.5 (P = 0.085, 0.010), disseminated cancer (P = 0.018, 0.001), and preadmission MMEs (P < 0.001) predict elevated 14-day and 30-day postdischarge MMEs. Conclusions: We conclude that perioperative analgesic procedures, as enhanced recovery pathway suggests, are neither predictive nor protective of postoperative discharge MMEs in colorectal surgery. Provider should account for preoperative risk factors when prescribing discharge opioid medications. Furthermore, providers should identify appropriate adjunct procedures to improve discharge opioid prescription stewardship.

Original language	English
Pages (from-to)	296-304
Number of pages	9
Journal	Journal of Surgical Research
Volume	283
DOIs	https://doi.org/10.1016/j.jss.2022.10.051
State	Published - Mar 2023

Bibliographical note

Publisher Copyright:
© 2022

Funding

This project was supported by Grant No. 2018-PM-BX-K051 awarded by the Bureau of Justice Assistance . The Bureau of Justice Assistances is a component of the U.S. Department of Justice's Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice. University of Kentucky Center for Clinical and Translational Science (CCTS). Clinical and Translational Science Award (CTSA) grant # UL1TR001998. The authors wish to thank the staff of the UK CCTS for their invaluable services and support throughout this research project. We further acknowledge the support from the Kentucky All Schedule Prescription Electronic Reporting (KASPER) program, Kentucky Cabinet for Health and Family Services.This project was supported by Grant No. 2018-PM-BX-K051 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistances is a component of the U.S. Department of Justice's Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice. University of Kentucky Center for Clinical and Translational Science (CCTS). Clinical and Translational Science Award (CTSA) grant # UL1TR001998 . The authors wish to thank the staff of the UK CCTS for their invaluable services and support throughout this research project. We further acknowledge the support from the Kentucky All Schedule Prescription Electronic Reporting (KASPER) program, Kentucky Cabinet for Health and Family Services.

Funders	Funder number
Kentucky All Schedule Prescription Electronic Reporting
Kentucky Cabinet for Health and Family Services
Kentucky Cabinet for Health and Family Services.This	2018-PM-BX-K051
U.S. Department of Justice
Bureau of Justice Assistance
National Institute of Justice
Office of Justice Programs
Office of Juvenile Justice and Delinquency Prevention
Center for Clinical and Translational Science, University of Illinois at Chicago	UL1TR001998
Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking
Office for Victims of Crime
Bureau of Justice Statistics
University of Kentucky, Center for Clinical and Translational Science

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Colorectal surgery
Opioid prescriptions
Postoperative pain control
Surgical recovery

ASJC Scopus subject areas

Surgery

Access to Document

10.1016/j.jss.2022.10.051

Cite this

@article{511b50b8b9ff48e69f39ab049c313416,

title = "Opioid Use After Colorectal Resection: Identifying Preoperative Risk Factors for Postoperative Use",

abstract = "Introduction: Appropriate prescribing practices are imperative to ensure adequate pain control, without excess opioid dispensing across colorectal patients. Methods: National Surgical Quality Improvement Program, Kentucky All Scheduled Prescription Electronic Reporting, and patient charts were queried to complete a retrospective study of elective colorectal resections, performed by a fellowship-trained colorectal surgeon, from January 2013 to December 2020. Opioid use at 14 d and 30 d posthospital discharge converted into morphine milligram equivalents (MMEs) were analyzed and compared across preadmission and inpatient factors. Results: One thousand four hundred twenty seven colorectal surgeries including 56.1\% (N = 800) partial colectomy, 24.1\% (N = 344) low anterior resection, 8.3\% (N = 119) abdominoperineal resection, 8.4\% (N = 121) sub/total colectomy, and 3.0\% (N = 43) total proctocolectomy. Abdominoperineal resection and sub/total colectomy patients had higher 30-day postdischarge MMEs (P < 0.001, P = 0.041). An operative approach did not affect postdischarge MMEs (P = 0.440). Trans abdominal plane blocks do not predict postdischarge MMEs (0.616). Epidural usage provides a 15\% increase in postdischarge MMEs (P = 0.020). Age (P < 0.001), smoking (P < 0.001), chronic obstructive pulmonary disease (P = 0.006, < 0.001), dyspnea (P = 0.001, < 0.001), albumin < 3.5 (P = 0.085, 0.010), disseminated cancer (P = 0.018, 0.001), and preadmission MMEs (P < 0.001) predict elevated 14-day and 30-day postdischarge MMEs. Conclusions: We conclude that perioperative analgesic procedures, as enhanced recovery pathway suggests, are neither predictive nor protective of postoperative discharge MMEs in colorectal surgery. Provider should account for preoperative risk factors when prescribing discharge opioid medications. Furthermore, providers should identify appropriate adjunct procedures to improve discharge opioid prescription stewardship.",

keywords = "Colorectal surgery, Opioid prescriptions, Postoperative pain control, Surgical recovery",

author = "Levy, \{Brittany E.\} and Castle, \{Jennifer T.\} and Ebbitt, \{Laura M.\} and Caleb Kennon and Erin McAtee and Davenport, \{Daniel L.\} and Evers, \{B. Mark\} and Avinash Bhakta",

note = "Publisher Copyright: {\textcopyright} 2022",

year = "2023",

month = mar,

doi = "10.1016/j.jss.2022.10.051",

language = "English",

volume = "283",

pages = "296--304",

}

TY - JOUR

T1 - Opioid Use After Colorectal Resection

T2 - Identifying Preoperative Risk Factors for Postoperative Use

AU - Levy, Brittany E.

AU - Castle, Jennifer T.

AU - Ebbitt, Laura M.

AU - Kennon, Caleb

AU - McAtee, Erin

AU - Davenport, Daniel L.

AU - Evers, B. Mark

AU - Bhakta, Avinash

PY - 2023/3

Y1 - 2023/3

N2 - Introduction: Appropriate prescribing practices are imperative to ensure adequate pain control, without excess opioid dispensing across colorectal patients. Methods: National Surgical Quality Improvement Program, Kentucky All Scheduled Prescription Electronic Reporting, and patient charts were queried to complete a retrospective study of elective colorectal resections, performed by a fellowship-trained colorectal surgeon, from January 2013 to December 2020. Opioid use at 14 d and 30 d posthospital discharge converted into morphine milligram equivalents (MMEs) were analyzed and compared across preadmission and inpatient factors. Results: One thousand four hundred twenty seven colorectal surgeries including 56.1% (N = 800) partial colectomy, 24.1% (N = 344) low anterior resection, 8.3% (N = 119) abdominoperineal resection, 8.4% (N = 121) sub/total colectomy, and 3.0% (N = 43) total proctocolectomy. Abdominoperineal resection and sub/total colectomy patients had higher 30-day postdischarge MMEs (P < 0.001, P = 0.041). An operative approach did not affect postdischarge MMEs (P = 0.440). Trans abdominal plane blocks do not predict postdischarge MMEs (0.616). Epidural usage provides a 15% increase in postdischarge MMEs (P = 0.020). Age (P < 0.001), smoking (P < 0.001), chronic obstructive pulmonary disease (P = 0.006, < 0.001), dyspnea (P = 0.001, < 0.001), albumin < 3.5 (P = 0.085, 0.010), disseminated cancer (P = 0.018, 0.001), and preadmission MMEs (P < 0.001) predict elevated 14-day and 30-day postdischarge MMEs. Conclusions: We conclude that perioperative analgesic procedures, as enhanced recovery pathway suggests, are neither predictive nor protective of postoperative discharge MMEs in colorectal surgery. Provider should account for preoperative risk factors when prescribing discharge opioid medications. Furthermore, providers should identify appropriate adjunct procedures to improve discharge opioid prescription stewardship.

AB - Introduction: Appropriate prescribing practices are imperative to ensure adequate pain control, without excess opioid dispensing across colorectal patients. Methods: National Surgical Quality Improvement Program, Kentucky All Scheduled Prescription Electronic Reporting, and patient charts were queried to complete a retrospective study of elective colorectal resections, performed by a fellowship-trained colorectal surgeon, from January 2013 to December 2020. Opioid use at 14 d and 30 d posthospital discharge converted into morphine milligram equivalents (MMEs) were analyzed and compared across preadmission and inpatient factors. Results: One thousand four hundred twenty seven colorectal surgeries including 56.1% (N = 800) partial colectomy, 24.1% (N = 344) low anterior resection, 8.3% (N = 119) abdominoperineal resection, 8.4% (N = 121) sub/total colectomy, and 3.0% (N = 43) total proctocolectomy. Abdominoperineal resection and sub/total colectomy patients had higher 30-day postdischarge MMEs (P < 0.001, P = 0.041). An operative approach did not affect postdischarge MMEs (P = 0.440). Trans abdominal plane blocks do not predict postdischarge MMEs (0.616). Epidural usage provides a 15% increase in postdischarge MMEs (P = 0.020). Age (P < 0.001), smoking (P < 0.001), chronic obstructive pulmonary disease (P = 0.006, < 0.001), dyspnea (P = 0.001, < 0.001), albumin < 3.5 (P = 0.085, 0.010), disseminated cancer (P = 0.018, 0.001), and preadmission MMEs (P < 0.001) predict elevated 14-day and 30-day postdischarge MMEs. Conclusions: We conclude that perioperative analgesic procedures, as enhanced recovery pathway suggests, are neither predictive nor protective of postoperative discharge MMEs in colorectal surgery. Provider should account for preoperative risk factors when prescribing discharge opioid medications. Furthermore, providers should identify appropriate adjunct procedures to improve discharge opioid prescription stewardship.

KW - Colorectal surgery

KW - Opioid prescriptions

KW - Postoperative pain control

KW - Surgical recovery

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UR - https://www.scopus.com/pages/publications/85142313567#tab=citedBy

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DO - 10.1016/j.jss.2022.10.051

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AN - SCOPUS:85142313567

SN - 0022-4804

VL - 283

SP - 296

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JO - Journal of Surgical Research

JF - Journal of Surgical Research

ER -

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

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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Cite this