Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 6/2019

01-06-2019 | 2018 SAGES Oral

Opioid-free colorectal surgery: a method to improve patient & financial outcomes in surgery

Authors: Deborah S. Keller, Jianying Zhang, Manish Chand

Published in: Surgical Endoscopy | Issue 6/2019

Login to get access

Abstract

Background

Opioids are a mainstay for postsurgical pain management, but have associated complications and costs, and contribute to the opioid epidemic. While efforts to reduce opioid use exist, little study has been done on opioid utilization and its impact across surgical approaches. Our goal was to evaluate the impact of opioid utilization on quality measures and costs after open and laparoscopic colorectal surgery.

Methods

The Premier database was reviewed for inpatient colorectal procedures from January 01, 2014, to September 30, 2015. Procedures were stratified into open and laparoscopic approaches, then “opioid” and “opioid-free” groups within each approach. Univariate analysis compared demographics, outcomes, and cost by opioid use and surgical approach. In the “opioid” groups, opioid consumption and duration were assessed across platforms. Multivariate regression analyzed the association between opioid use and surgical approach on costs and quality outcomes.

Results

50,098 procedures were evaluated—40.4% laparoscopic and 59.6% open. 6.6% of laparoscopic and 5.3% of open cases were “opioid free.” Across both approaches, patients over 65 were most likely opioid free, while the obese and cancer patients were most likely to use opioids. Length of stay was shorter, and post-discharge nursing needs and total costs were lower in the “opioid-free” group in both approaches (all p < 0.001). The median daily and total opioid consumption were lower with a laparoscopic approach (p < 0.001), which also had a shorter duration of use versus open cases (p < 0.001). Opioids were 20% more likely in open cases. Total costs were 16% greater with opioids and 24% greater in open surgery. Complications were 89% more likely in open surgery. Readmissions were increased by 14% with both opioid use and open surgery.

Conclusions

Opioid-free colorectal surgery results in improved outcomes, and laparoscopy further improves these results. Continued efforts to increase laparoscopy are key for reducing opioids and improving outcomes as we transition to value-based care.
Appendix
Available only for authorised users
Literature
1.
Kenan K, Mack K, Paulozzi L (2012) Trends in prescriptions for oxycodone and other commonly used opioids in the United States, 2000–2010. Open Med 6:e41–e47PubMedPubMedCentral
2.
Centers for Disease Control and Prevention CDC (2017) Wide-ranging online data for epidemiologic research (WONDER). CDC, National Center for Health Statistics, Atlanta. http://​wonder.​cdc.​gov
3.
Hedegaard H, Warner M, Miniño AM. Drug Overdose Deaths in the United States, 1999–2016. NCHS Data Brief. 20171-8
4.
Kochanek KDMSL, Xu JQ, Arias E (2017) Mortality in the United States, 2016. NCHS Data Brief, No. 293. National Center for Health Statistics, Hyattsville
5.
Center for Behavioral Health Statistics and Quality (2017) 2016 National Survey on Drug Use and Health: detailed tables. Substance Abuse and Mental Health Services Administration, Rockville
6.
Paulozzi LJ, Jones CM, Mack KA et al (2011) Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep 60:1487–1492
7.
Carlson RG, Nahhas RW, Martins SS, Daniulaityte R (2016) Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: a natural history study. Drug Alcohol Depend 160:127–134CrossRefPubMedPubMedCentral
8.
Bartels K, Mayes LM, Dingmann C, Bullard KJ, Hopfer CJ, Binswanger IA (2016) Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS ONE 11:e0147972CrossRefPubMedPubMedCentral
9.
Florence CS, Zhou C, Luo F, Xu L (2016) The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 54:901–906CrossRefPubMedPubMedCentral
10.
11.
Fox CD, Berger D. Fine PG et al (2000) Pain assessment and treatment in the managed care environment. A position statement from the American Pain Society. American Pain Society, Glenview
12.
Baker DW (2017) History of The Joint Commission’s Pain Standards: lessons for today’s prescription opioid epidemic. JAMA 317:1117–1118CrossRefPubMed
13.
Gupta A, Lee LK, Mojica JJ, Nairizi A, George SJ (2014) Patient perception of pain care in the United States: a 5-year comparative analysis of hospital consumer assessment of health care providers and systems. Pain Phys 17:369–377
14.
15.
Kessler ER, Shah M, Gruschkus SK, Raju A (2013) Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy 33:383–391CrossRefPubMed
16.
Minkowitz HS, Gruschkus SK, Shah M, Raju A (2014)Adverse drug events among patients receiving postsurgical opioids in a large health system: risk factors and outcomes. Am J Health Syst Pharm 71(18):1556–1565CrossRefPubMed
17.
Tan M, Law LS, Gan TJ (2015) Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth 62:203–218CrossRefPubMed
18.
Sun EC, Darnall BD, Baker LC, Mackey S (2016) Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 176:1286–1293CrossRefPubMedPubMedCentral
19.
20.
Brummett CM, Waljee JF, Goesling J et al (2017) New persistent opioid use after minor and major surgical procedures in US Adults. JAMA Surg 152:e170504CrossRefPubMedPubMedCentral
21.
Carroll I, Barelka P, Wang CK et al (2012) A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg 115:694–702PubMed
22.
Brandal D, Keller MS, Lee C et al (2017) Impact of enhanced recovery after surgery and opioid-free anesthesia on opioid prescriptions at discharge from the hospital: a historical-prospective study. Anesth Analg 125:1784–1792CrossRefPubMedPubMedCentral
23.
Wick EC, Grant MC, Wu CL (2017) Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 152:691–697CrossRefPubMed
24.
Joshi GP (2005) Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North America 23:185–202CrossRefPubMed
25.
Carmichael JC, Keller DS, Baldini G et al (2017) Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60:761–784CrossRefPubMed
26.
Pache B, Hübner M, Jurt J, Demartines N, Grass F (2017) Minimally invasive surgery and enhanced recovery after surgery: the ideal combination. J Surg Oncol 116:613–616CrossRefPubMed
27.
Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875CrossRefPubMed
28.
Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453CrossRefPubMedPubMedCentral
29.
Thiele RH, Rea KM, Turrentine FE et al (2015) Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg 220:430–443CrossRefPubMed
30.
31.
Control NCFIPA (2016) CDC compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors, 2016 version. Centers for Disease Control and Prevention, Atlanta. https://​www.​cdc.​gov/​drugoverdose/​media/​
32.
33.
Rudd RA, Aleshire N, Zibbell JE, Gladden RM (2016) Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep 64:1378–1382CrossRefPubMed
34.
Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD (2016) Opioids prescribed after low-risk surgical procedures in the United States, 2004–2012. JAMA 315:1654–1657CrossRefPubMedPubMedCentral
35.
Jiang X, Orton M, Feng R et al (2017) Chronic opioid usage in surgical patients in a Large Academic Center. Ann Surg 265:722–727CrossRefPubMed
36.
Keller DS, Delaney CP, Hashemi L, Haas EM (2016) A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc 30:4220–4228CrossRefPubMed
37.
Strassels SA (2009) Economic burden of prescription opioid misuse and abuse. J Manag Care Pharm 15:556–562PubMed
38.
Waljee JF, Li L, Brummett CM, Englesbe MJ (2017) Iatrogenic opioid dependence in the United States: are Surgeons the Gatekeepers. Ann Surg 265:728–730CrossRefPubMed
39.
Jones CM, Logan J, Gladden RM, Bohm MK (2015) Vital signs: demographic and substance use trends among heroin users—United States, 2002–2013. MMWR Morb Mortal Wkly Rep 64:719–725CrossRefPubMedPubMedCentral
40.
Waljee JF, Cron DC, Steiger RM, Zhong L, Englesbe MJ, Brummett CM (2017) Effect of preoperative opioid exposure on healthcare utilization and expenditures following elective abdominal surgery. Ann Surg 265:715–721CrossRefPubMed
41.
Stafford C, Francone T, Roberts PL, Ricciardi R (2018) What factors are associated with increased risk for prolonged postoperative opioid usage after colorectal surgery. Surg Endosc 32:3557–3561CrossRef
Metadata
Title
Opioid-free colorectal surgery: a method to improve patient & financial outcomes in surgery
Authors
Deborah S. Keller
Jianying Zhang
Manish Chand
Publication date
01-06-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6477-5

Other articles of this Issue 6/2019

Surgical Endoscopy 6/2019 Go to the issue

OriginalPaper

Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience

OriginalPaper

Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique

2018 SAGES Oral

Bariatric surgery in patients with interstitial lung disease

Dynamic Manuscript

Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct

OriginalPaper

Surgical starting time in the morning versus the afternoon: propensity score matched analysis of operative outcomes following laparoscopic colectomy for colorectal cancer

Dynamic Manuscript

Gastric access temporary for endoscopy (GATE): a proposed algorithm for EUS-directed transgastric ERCP in gastric bypass patients