M. Sunkara1, R. C. Martin1, P. Philips1, K. M. McMasters1, C. R. Scoggins1, M. E. Egger1 1University Of Louisville,Surgery,Louisville, KY, USA
Introduction: Patients undergoing complex gastrointestinal surgery often take narcotics prior to surgery for chronic pain. The impact of the use of preoperative narcotics on perioperative outcomes and long-term narcotic use are unknown. We hypothesized that use of preoperative narcotics would negatively impact perioperative outcomes in patients undergoing complex gastrointestinal surgery.
Methods: Patients undergoing complex gastrointestinal surgery in an academic surgical oncology practice were identified from a prospectively collected database. Complex gastrointestinal surgery was defined as an operation requiring general anesthesia and an inpatient stay involving gastric, esophageal, hepatic, or pancreatic resection, or cytoreductive surgery for peritoneal malignancy. Medication use was determined by review of the medical records. Perioperative outcomes, including complications, length of stay, and 90 day readmission were compared. Major complications were defined as Clavien-Dindo grade 3 or greater. Early postoperative narcotic use was defined as continued use of narcotics at 30 days postoperatively, and prolonged postoperative narcotic use was defined as use of narcotics 90 days postoperatively.
Results: We identified 162 patients in the 5-year time period of the study meeting inclusion criteria with records available for review. The most common operation was esophagectomy (34%), followed by pancreatic resection (26.5%), gastrectomy (15%), and hepatic resection (14%). Most patients (96.3%) underwent surgery for a malignancy. The rate of preoperative narcotic use was 36% overall. The rate of preoperative benzodiazepine use was 16% overall. There were no differences in 90-day readmission rates (14% vs 12%), complication rates (46 vs 48%), major complication rates (19% vs 23%), length of stay (10 vs 9 days), or prolonged length of stay ≥ 14 days (27% vs 29%) in patients who did and did not use narcotics preoperatively. Preoperative benzodiazepine use was not associated with any differences in perioperative complications. Preoperative narcotic use was associated with an increased rate of early postoperative narcotic use at 30 days (90% vs 61%, OR 5.9, 95% CI 1.9-18.3) and prolonged postoperative narcotic use at 90 days (63% vs 29%, OR 4.3, 95% CI 1.9-9.7) (Figure). Neither complications nor preoperative benzodiazepine use predicted early or prolonged postoperative narcotic use.
Conclusion: Perioperative complications are similar in patients who are taking preoperative narcotics compared those that are not. However, patients using narcotics prior to complex gastrointestinal surgery are at increased risk of prolonged narcotic use after surgery. This group may be a target for early intervention to decrease the risk of opioid dependency.
