This article presents the research methodology and findings of a study that evaluated preoperative risk factors that may predict post-discharge opioid prescriptions in colorectal resection patients.
Appropriate prescribing practices are imperative to ensure adequate pain control, without excess opioid dispensing across colorectal patients. National Surgical Quality Improvement Program, Kentucky All Scheduled Prescription Electronic Reporting, and patient charts were queried to complete a retrospective study of elective colorectal resections, performed by a fellowship-trained colorectal surgeon, from January 2013 to December 2020. Opioid use at 14- and 30-days post-hospital discharge converted into morphine milligram equivalents (MMEs) were analyzed and compared across preadmission and inpatient factors. Abdominoperineal resection and sub/total colectomy patients had higher 30-day post-discharge MMEs. An operative approach did not affect post-discharge MMEs. Trans abdominal plane blocks did not predict post-discharge MMEs. Epidural usage provided a 15 percent increase in post-discharge MMEs. Age, smoking, chronic obstructive pulmonary disease, dyspnea, albumin, disseminated cancer, and preadmission MMEs predicted elevated 14-day and 30-day post-discharge MMEs. The authors conclude that perioperative analgesic procedures, as enhanced recovery pathway suggests, are neither predictive nor protective of postoperative discharge MMEs in colorectal surgery; and the provider should account for preoperative risk factors when prescribing discharge opioid medications. Furthermore, providers should identify appropriate adjunct procedures to improve discharge opioid prescription stewardship. Publisher Abstract Provided
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