Pain and opioid use after colorectal resection for benign versus malignant disease: A single institution analysis

Sarah Diaz; Kara K Brockhaus; Matthew C Bobel; Sara M Colom; Carole Ramm; Robert K Cleary

doi:10.1016/j.amjsurg.2024.01.034

Pain and opioid use after colorectal resection for benign versus malignant disease: A single institution analysis

Am J Surg. 2024 Feb 8:S0002-9610(24)00036-9. doi: 10.1016/j.amjsurg.2024.01.034. Online ahead of print.

Authors

Sarah Diaz¹, Kara K Brockhaus², Matthew C Bobel¹, Sara M Colom³, Carole Ramm⁴, Robert K Cleary⁵

Affiliations

¹ Department of Surgery, St Joseph Mercy Hospital Ann Arbor, Ann Arbor, MI, USA.
² Department of Pharmacy, St Joseph Mercy Hospital Ann Arbor, Ann Arbor, MI, USA.
³ Methods Consultants, Ypsilanti, MI, USA.
⁴ Department of Academic Research, St Joseph Mercy Hospital Ann Arbor, Ann Arbor, MI, USA.
⁵ Department of Surgery, St Joseph Mercy Hospital Ann Arbor, Ann Arbor, MI, USA. Electronic address: Robert.Cleary@trinity-health.org.

PMID: 38365550
DOI: 10.1016/j.amjsurg.2024.01.034

Abstract

Background: Studies comparing opioid needs between benign and malignant colorectal diseases are inconclusive.

Methods: Single institution analysis of prospectively maintained colorectal surgery database. Multiple regression analyses done on perioperative numeric pain scores (NPS) and opioids prescribed at discharge.

Results: 641 patients in Benign and 276 patients in the Malignant group. Unadjusted comparison revealed significantly higher NPS for the Benign than the Malignant group preoperative and postoperative day 0 (after surgery), 1, 2, and 3 (all p ≤ 0.001). Opioids prescribed at discharge were significantly higher in the Benign group (60.0% vs 51.1%, p = 0.018). After regression analysis, there was no longer a significant difference in NPS (B = 0.703, p = 0.095) and opioids prescribed between groups [OR = 0.803 (95%CI 0.586, 1.1), p = 0.173].

Conclusions: Pain and opioids prescribed at discharge are not significantly different between benign and malignant diseases in an enhanced recovery pain management pathway that maximizes non-opioid multimodal analgesic strategies.

Keywords: Colon; Colorectal; Opioid; Pain; Rectum.