A Retrospective Review: Patient-Reported Preoperative Prescription Opioid, Sedative, or Antidepressant Use Is Associated with Worse Outcomes in Colorectal Surgery.

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. REVISION RETROSPECTIVA: EL USO DE OPIOIDES, SEDANTES O ANTIDEPRESORES EN EL PREOPERATORIO SE ASOCIAN CON MALOS RESULTADOS EN CIRUGIA COLORECTAL: El uso de opioides, sedantes y antidepresores esta en aumento. No se ha establecido el efecto de estos medicamentos en los resultados de la cirugia colorrectal.Evaluar el impacto del uso preoperatorio de opioides, sedantes y antidepresores en los resultados despues de una cirugia colorrectal.Base de datos retrospectiva y revision de registros medicos.Este estudio se realizo en la Universidad de Kentucky utilizando la base de datos del Proyecto de Mejora de Calidad Quirurgica Nacional del Colegio Estadounidense de Cirujanos.Todos los pacientes ≥ 18 anos que se sometieron a una reseccion colorrectal por diversas indicaciones, excluyendo los traumas, entre el 1 de Enero de 2013 y el 31 de Diciembre de 2016.Tasas de morbilidad y mortalidad postoperatorias a los 30 dias.De 1201 pacientes, 30.2% usaron opioides, 18.4% usaron sedantes y 28.3% usaron antidepresores antes de la cirugia. Los pacientes tratados con cualquiera de los medicamentos mencionados, presentaban un ASA mas elevado, tasas de disnea y EPOC mas graves en comparacion con pacientes sin tratamiento previo. Los consumidores de opioides tambien tuvieron tasas mas altas de creacion de ostomias, clasificacion mas alta de heridas contaminadas, un tiempo de operacion prolongado y transfusion postoperatoria mayor. Despues de la cirugia los pacientes que tuvieron tasas mas altas de infeccion intraabdominal (opioides: 21.5% vs 15.2%, p = 0.009, sedantes: 23.1% vs 15.7%, p = 0.01, antidepresivos: 22.4% vs 15.0%, p = 0.003) e insuficiencia respiratoria (opioides: 11.0% vs 6.3%, p = 0.007, sedantes: 12.2% vs 6.7%, p = 0.008, antidepresivos: 10.9% vs 6.5%, p = 0.02). Los consumidores de opioides o sedantes tuvieron una estadia hospitalaria prolongada de mas de 2 dias (p <0.001) en comparacion con los consumidores. Despues de haber realizado el ajuste de todos los predictores de mal pronostico, el uso de opioides y sedantes se asocio con una mayor morbilidad y mortalidad a los 30 dias despues de cirugia colorrectal (OR 1.43 [IC 95% 1.07-1.91] y OR 1.48 [IC 95% 1.05-2.08], respectivamente)Revision retrospectiva, estudio de una sola institucion, factores de confusion no evaluados.Identificamos que el consumo de opiaceos y sedantes recetados a los pacientes se asocian con resultados adversos complejos mas alla de 30 dias en casos de reseccion colorrectal, destacando la necesidad de su respectiva evaluacion como componentes de la estratificacion de riesgo preoperatorio. Consulte Video Resumen http://links.lww.com/DCR/B226. (Traduccion-Dr. Xavier Delgadillo).