Long-Term Opioid Use After Colon and Rectal Surgery

Abstract

Introduction: The United States continues to struggle with the opioid epidemic. Enhanced recovery after surgery (ERAS) pathways aim to limit opioid use in the perioperative setting. The goal of this study was to examine whether standardized, nonnarcotic medications are associated with a decrease in long-term opioid use after colorectal surgery in opioid-naïve patients.

Materials and methods: This was a retrospective cohort study from 2017 to 2020 with 1 y duration of follow-up. Data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program and Epic Systems Cooperation from five institutions in the Mass General Brigham Colorectal Surgery Collaborative. Opiate naïve patients undergoing colorectal surgery were selected using standardized Current Procedural Terminology codes. Between 2017 and 2020, a standardized ERAS protocol was developed at all five sites. The primary outcome was long-term opioid use after surgery defined as persistent opioid use at 6 and 12 mo.

Results: A total of 1363 opioid-naïve patients undergoing colorectal surgery were included in the study. From 2017 to 2020, nearly all patients were prescribed opioids. From 2017 to 2018, 16% and 11% of patients continued to use opioids at 6 and 12 mo, respectively, compared to 15% and 8% of patients from 2018 to 2019, and 11% and 4% of patients from 2019 to 2020, P < 0.01.

Conclusions: Although a small proportion of opioid-naïve patients remain on opioids at 1 y postoperatively, we show a stepwise reduction from 2017 to 2020 after standardization of opioid-sparing strategies in ERAS pathways.

Keywords: Collaborative; Colorectal; ERAS; Opioid reduction; Surgery.