Post-discharge Opioid Consumption After Minimally Invasive and Open Colectomy: Does Operative Approach Matter?
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
pubmed:
14
7
2020
medline:
27
4
2022
entrez:
14
7
2020
Statut:
ppublish
Résumé
To determine if patients consume less opioid after minimally invasive colectomy compared to open colectomy. Opioids are overprescribed after surgery, and surgeons are under increasing pressure to reduce postoperative opioid prescribing. In colorectal surgery, minimally invasive approaches are partly justified by reduced inpatient opioid use, but there are no studies comparing post-discharge opioid consumption between minimally invasive and open colectomy. This was a retrospective observational study of adult patients undergoing colectomy from January 2017 to May 2018 in the Michigan Surgical Quality Collaborative database. After postoperative day 30, patients were contacted by phone or email and asked to report post-discharge opioid consumption. The main outcome measure was post-discharge opioid consumption, and the primary predictor was surgical approach (minimally invasive vs open). Zero-inflated negative binomial regression analysis was used to test for an association between surgical approach and opioid consumption. We identified 562 patients who underwent minimally invasive or open colectomy from 43 hospitals. After multivariable adjustment, no significant difference was demonstrated in opioid consumption (P = 0.54) or the likelihood of using no opioids (P = 0.39) between patients undergoing minimally versus open colectomy. Larger prescriptions were associated with more opioid use and a lower likelihood of using no opioids. Age greater than 65 and diagnosis of cancer/adenoma were associated with less opioid use. Patients undergoing minimally invasive and open colectomy consume similar amounts of opioid after discharge. The size of the postoperative prescription, patient age, and diagnosis are more important in determining opioid use. Understanding factors influencing postoperative opioid requirements may allow surgeons to better tailor prescriptions to patient needs.
Sections du résumé
OBJECTIVE
To determine if patients consume less opioid after minimally invasive colectomy compared to open colectomy.
BACKGROUND
Opioids are overprescribed after surgery, and surgeons are under increasing pressure to reduce postoperative opioid prescribing. In colorectal surgery, minimally invasive approaches are partly justified by reduced inpatient opioid use, but there are no studies comparing post-discharge opioid consumption between minimally invasive and open colectomy.
METHODS
This was a retrospective observational study of adult patients undergoing colectomy from January 2017 to May 2018 in the Michigan Surgical Quality Collaborative database. After postoperative day 30, patients were contacted by phone or email and asked to report post-discharge opioid consumption. The main outcome measure was post-discharge opioid consumption, and the primary predictor was surgical approach (minimally invasive vs open). Zero-inflated negative binomial regression analysis was used to test for an association between surgical approach and opioid consumption.
RESULTS
We identified 562 patients who underwent minimally invasive or open colectomy from 43 hospitals. After multivariable adjustment, no significant difference was demonstrated in opioid consumption (P = 0.54) or the likelihood of using no opioids (P = 0.39) between patients undergoing minimally versus open colectomy. Larger prescriptions were associated with more opioid use and a lower likelihood of using no opioids. Age greater than 65 and diagnosis of cancer/adenoma were associated with less opioid use.
CONCLUSIONS
Patients undergoing minimally invasive and open colectomy consume similar amounts of opioid after discharge. The size of the postoperative prescription, patient age, and diagnosis are more important in determining opioid use. Understanding factors influencing postoperative opioid requirements may allow surgeons to better tailor prescriptions to patient needs.
Identifiants
pubmed: 32657943
pii: 00000658-202204000-00020
doi: 10.1097/SLA.0000000000004240
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
753-758Subventions
Organisme : NIDA NIH HHS
ID : R01 DA042859
Pays : United States
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to report.
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