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Opioid, sedative and antidepressant use pre- colorectal surgery leads to worse outcomes

Mon, 06/08/2020 - 15:50
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A study led by University of Kentucky Markey Cancer Center researchers showed that patients who already used opioids, sedatives or antidepressants prior to colorectal surgery experience significantly more complications post-surgery.

The study, 'A Retrospective Review: Patient-Reported Preoperative Prescription Opioid, Sedative, or Antidepressant Use Is Associated with Worse Outcomes in Colorectal Surgery', published in Diseases of the Colon & Rectum, aimed to evaluate the impact of preoperative prescription opioid, sedative, and antidepressant use on postoperative outcomes following colorectal surgery. The primary outcomes measured were the rates of 30-day postoperative morbidity and mortality.

The preoperative use of opioids, sedatives and antidepressants is on the rise in the US. Though the current opioid crisis has raised awareness for limiting opioid use, many patients still receive opioids for pain management, and finding the right balance of medication is an ongoing issue for many patients and doctors. Patients with anxiety disorders or other mental health issues often receive sedatives or antidepressants.

However, risk prediction models for postoperative complications do not take these common medications into consideration, he added. To reduce complications post-surgery, he stated that more needs to be done to help patients reduce their need for these drugs in managing pain and anxiety prior to any major surgery.

Avinash Bhakta (Credit: University of Kentucky)
Avinash Bhakta (Credit: University of Kentucky)

"Most colorectal resections are elective in nature, so we want to focus on the use of opioids and sedatives and counsel patients on the need to decrease the use of these drugs before surgery," said Dr Avinash Bhakta, a colorectal surgeon at the UK Markey Cancer Center and lead author on the study. "These drugs are necessary for many patients, but if we can decrease how much they're using, we can help decrease long-term complications. Not only do we want to improve their surgical outcomes, we want to improve their overall health."

Utilising the local American College of Surgeons National Surgical Quality Improvement Project database, the study examined 1,201 patients 18 years of age and older who underwent colorectal resection for any indication other than trauma at UK HealthCare. Of these patients, roughly 30% used opioids, 28% used antidepressants and 18% used sedatives, all legally prescribed by a doctor pre-operatively.

Patients on any of these medications showed an increase in several common complications post-surgery, including infections, prolonged intubation, longer length of stay, readmissions, respiratory failure and even mortality. These problems were particularly pronounced in patients who regularly used opioids prior to surgery.

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.

“We identified that patient-reported prescription opioid and sedative use is associated with higher 30-day composite adverse outcomes in colorectal resections,” the authors concluded. “Highlighting the need for the evaluation of opioid and sedative use as a component of the preoperative risk stratification.”