N. Jackson1, J. Castle1, D. Davenport1, J. Patel1, J. Hourigan1, S. Beck1, A. Bhakta1 1University Of Kentucky,Colorectal Surgery,Lexington, KY, USA
Introduction:
Colorectal resections are increasing. Unfortunately, many of these patients are on multiple medications, including opioids (OPD), anxiolytics (AXM) and antidepressants (ADM). No literature exists on the relationship of these medications to postoperative outcomes following colorectal surgery. The purpose of this study was to evaluate the impact of pre-operative use of OPD, AXM, and ADM on post-operative outcomes following colorectal surgery.
Methods:
The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was queried for all patients undergoing colectomy at a university-based tertiary care hospital from January 1, 2013 to December 31, 2016. Retrospective chart review was performed to gather demographic data, preoperative use of OPD, AXM, and ADM, intraoperative variables, and postoperative outcomes. Stepwise regression models were utilized to assess the impact of preoperative OPD, AXM, and ADM use on postoperative complications. Rates of 30-day morbidity and mortality in patients on preoperative OPD, AXM, and ADM medications following colorectal procedures were assessed.
Results:
The query yielded 1201 patients, 30.2% (n=363) took OPD preoperatively, 18.4% (n=221) used AXM, and 28.3% (n=340) used ADM. Patients on these medications had significantly increased rates of adverse outcomes (OPD 44.4% vs 30.1% naive, p≤0.001; AXM 43.0% vs 32.9% naive, p≤0.001; ADM 40.6% vs 32.4% naive, p≤0.01). These patients had increased incidence of intra-abdominal infection (OPD: 21.5% vs 15.2% naive, p≤0.01, AXM: 23.1% vs 15.7% naive, p≤0.01, ADM: 22.4% vs 15.0% naive, p<0.05) and prolonged intubation or unplanned reintubation (OPD: 11.0% vs 6.3% naive, p≤0.01, AXM: 12.2% vs 6.7% naive, p≤0.01, ADM: 10.9% vs 6.5% naive, p<0.05). Patients on OPD and AXM had hospital lengths of stay prolonged by 2 days (p≤0.001). Those taking OPD had higher rates of readmission (17.9% vs 11.0% naive, p≤0.01) and more likely to require ostomy creation (51.5% vs 37.8% naive, p≤0.001). On multivariate regression, OPD and AXM use were associated with increased 30-day morbidity and mortality following colorectal procedures (OR: 1.48, p≤0.01; OR: 1.47, p<0.05, respectively).
Conclusion:
Preoperative OPD, AXM and ADM use is associated with increased adverse outcomes, 30-day morbidity and mortality following colorectal surgery. These medications should be considered in preoperative planning and be adjusted for in postoperative measures.