Olleik Ghadeer, Lapointe-Gagner Maxime, Jain Shrieda, Shirzadi Samin, Nguyen-Powanda Philip, Al Ben Ali Sarah, Ghezeljeh Tahereh Najafi, Elhaj Hiba, Alali Naser, Fermi Francesca, Pook Makena, Mousoulis Christos, Almusaileem Ahmad, Farag Nardin, Dmowski Katy, Cutler Danielle, Kaneva Pepa, Agnihotram Ramanakumar V, Feldman Liane S, Boutros Marylise, Lee Lawrence, Fiore Julio F
Department of Surgery, McGill University, Montreal, QC, Canada.
Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Surg Endosc. 2025 Jan;39(1):492-503. doi: 10.1007/s00464-024-11322-8. Epub 2024 Oct 14.
Opioid overprescription after colorectal surgery can lead to adverse events, persistent opioid use, and diversion of unused pills. This study aims to assess the extent to which opioids prescribed at discharge after elective colorectal surgery are consumed by patients.
This prospective cohort study included adult patients (≥ 18 yo) undergoing elective colorectal surgery at two academic hospitals in Montreal, Canada. Patients completed preoperative questionnaires and data concerning demographics, surgical details, and perioperative care characteristics (including discharge prescriptions) were extracted from electronic medical records. Self-reported opioid consumption was assessed weekly up to 1-month post-discharge. The total number of opioid pills prescribed and consumed after discharge were compared using the Wilcoxon signed-rank test. Negative binomial regression was used to identify predictors of opioid consumption.
We analyzed 344 patients (58 ± 15 years, 47% female, 65% laparoscopic, 31% rectal resection, median hospital stay 3 days [IQR 1-5], 18% same-day discharge). Most patients received a TAP block (67%). Analgesia prescription at discharge included acetaminophen (92%), NSAIDs (38%), and opioids (92%). The quantity of opioids prescribed at discharge (median 13 pills [IQR 7-20]) was significantly higher than patient-reported consumption at one month (median 0 pills [IQR 0-7]) (p < 0.001). Overall, 51% of patients did not consume any opioids post-discharge, and 63% of the prescribed pills were not used. Increased opioid consumption was associated with younger age (IRR 0.99 [95%CI 0.98-0.99]), higher preoperative anxiety (1.02 [95%CI 1.00-1.04]), rectal resections (IRR 1.45 [95%CI 1.09-1.94]), and number of pills prescribed (1.02 [95%CI 1.01-1.03]).
A considerable number of opioid pills prescribed at discharge after elective colorectal surgery are left unused by patients. Certain patient and care characteristics were associated with increased opioid consumption. Our findings indicate that post-discharge analgesia with minimal or no opioids may be feasible and warrants further investigation.
结直肠手术后阿片类药物的过度处方可能导致不良事件、持续使用阿片类药物以及未使用药丸的转移。本研究旨在评估择期结直肠手术后出院时开具的阿片类药物被患者服用的程度。
这项前瞻性队列研究纳入了在加拿大蒙特利尔的两家学术医院接受择期结直肠手术的成年患者（≥18岁）。患者完成术前问卷，并从电子病历中提取有关人口统计学、手术细节和围手术期护理特征（包括出院处方）的数据。出院后每周评估一次自我报告的阿片类药物消耗量，直至出院后1个月。使用Wilcoxon符号秩检验比较出院后开具和服用的阿片类药丸总数。负二项回归用于确定阿片类药物消耗的预测因素。
我们分析了344例患者（58±15岁，47%为女性，65%为腹腔镜手术，31%为直肠切除术，中位住院时间3天[IQR 1-5]，18%为当日出院）。大多数患者接受了腹横肌平面阻滞（67%）。出院时的镇痛处方包括对乙酰氨基酚（92%）、非甾体抗炎药（38%）和阿片类药物（92%）。出院时开具的阿片类药物数量（中位13粒药丸[IQR 7-20]）显著高于患者报告的1个月消耗量（中位0粒药丸[IQR 0-7]）（p<0.001）。总体而言，51%的患者出院后未服用任何阿片类药物，63%的开具药丸未被使用。阿片类药物消耗量增加与年龄较小（IRR 0.99[95%CI 0.98-0.99]）、术前焦虑较高（1.02[95%CI 1.00-1.04]）、直肠切除术（IRR 1.45[95%CI 1.09-1.94]）以及开具的药丸数量（1.02[95%CI 1.01-1.03]）有关。
择期结直肠手术后出院时开具的相当数量的阿片类药丸未被患者使用。某些患者和护理特征与阿片类药物消耗量增加有关。我们的研究结果表明，出院后使用最少或不使用阿片类药物进行镇痛可能是可行的，值得进一步研究。
