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Postoperative Opioid Use Is Associated with Increased Rates of Grade B/C Pancreatic Fistula After Distal Pancreatectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major source of morbidity after distal pancreatectomy. This study examined the association between postoperative opioid use and CR-POPF in the context of opioid-sparing postoperative care.

Methods

A case–control study was performed on consecutive patients who underwent distal pancreatectomy between October 2016 and April 2022 at a single institution. Patients who developed CR-POPF were compared to controls. Multivariable regression modeling was used to identify factors associated with CR-POPF.

Results

A total of 281 patients underwent 187 open, 20 laparoscopic, and 74 robotic-assisted operations. The rate of CR-POPF was 21% (n = 58). CR-POPF rate declined from 32 to 8% over the study period (p < 0.001). Median oral morphine equivalents (OME) administered on POD 0–1 and 0–3 were 94 and 129 mg, respectively, in patients who did not develop a fistula versus 130 and 180 mg in those who did (both p ≤ 0.001). POD 0–3 OME (OR 1.11, p = 0.044) was independently associated with increased odds of CR-POPF, with each additional 50 mg (equivalent to 10 tramadol pills) increasing the relative risk by 11% and absolute risk by 2%.

Conclusion

Early postoperative opioid use after distal pancreatectomy was associated with increased odds of CR-POPF. Decreasing perioperative opioid use through enhanced postoperative management is a low-cost and generalizable approach that may reduce rates of CR-POPF after distal pancreatectomy.

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Data Availability

Data may be made available upon reasonable request from the PI with institutional and legal approvals.

Abbreviations

CR-POPF:

Clinically relevant postoperative pancreatic fistula

OME:

Oral morphine equivalents

DP:

Distal pancreatectomy

ISGPS:

International Study Group for Pancreas Surgery

NSQIP:

National Surgical Quality Improvement Program

SO:

Sphincter of Oddi

RSPCPs:

Risk-stratified pancreatectomy clinical pathways

EHR:

Electronic health record

POD:

Postoperative day

NSAIDs:

Non-steroidal anti-inflammatory drugs

BMI:

Body mass index

EBL:

Estimated blood loss

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Artem Boyev, Laura R. Prakash, Yi-Ju Chiang, Christopher P. Childers, Anish J. Jain, Timothy E. Newhook, Morgan L. Bruno, Elsa M. Arvide, Whitney L. Dewhurst, Michael P. Kim, Naruhiko Ikoma, Jeffrey E. Lee, Rebecca A. Snyder, Matthew H. G. Katz, Ching-Wei D. Tzeng & Jessica E. Maxwell

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This project was presented as an oral presentation at the Americas Hepato-Pancreato-Biliary Association (AHPBA) 2023 Annual Meeting and as a long oral presentation at the 2023 Pancreas Club Meeting.

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Boyev, A., Prakash, L.R., Chiang, YJ. et al. Postoperative Opioid Use Is Associated with Increased Rates of Grade B/C Pancreatic Fistula After Distal Pancreatectomy. J Gastrointest Surg 27, 2135–2144 (2023). https://doi.org/10.1007/s11605-023-05751-4

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