Surgical Endoscopy

, Volume 32, Issue 8, pp 3557–3561 | Cite as

What factors are associated with increased risk for prolonged postoperative opioid usage after colorectal surgery?

  • Caitlin StaffordEmail author
  • Todd Francone
  • Patricia L. Roberts
  • Rocco Ricciardi



Opioid-related deaths have increased substantially over the last 10 years placing clinician’s prescription practices under intense scrutiny. Given the substantial risk of opioid dependency after colorectal surgery, we sought to analyze risk of postoperative prolonged opioid use after colorectal resections.


Between 2008 and 2014, patients undergoing abdominopelvic procedure with intestinal resection at a tertiary care facility were retrospectively identified. Patient’s postoperative narcotic usage including their prescriptions on discharge and their total opioid medication use was recorded. Patient variables such as demographics, surgical characteristics, and prescription use were evaluated. Finally, we developed multivariate models to identify risk factors for prolonged opioid use (> 30 days after incident surgical procedure).


We identified 9423 recorded procedures of which 2173 consisted of abdominopelvic procedures with intestinal resection and survived > 1 year. Of these, 91% (n = 1981) were discharged on opioids, and 98% (n = 1955) of those patients filled only one prescription. A total of 92 (4%) patients remained on opioids beyond 30 days, and from this group, 25% (n = 23 patients) remained at 90 days. We found no association between postoperative complications, stoma formation, and patient’s sex with risk of prolonged opioid use. However, younger age and history of chronic pain were associated with an increased risk of prolonged opioid use. The use of minimally invasive techniques also attenuated the risk of prolonged opioid use (Table 2).


A small but considerable proportion of patients remain on opioids beyond 30 days. Predictors of opioid use for greater than 30 days include a history of chronic pain and younger age. The use of minimally invasive techniques reduced the risk of prolonged opioid use. We identified several immutable risk factors that predicted prolonged postoperative opioid use; however, surgeons may be able to attenuate prolonged opioid use through the use of minimally invasive techniques.


Opioid use Minimally invasive techniques Postoperative care 


Compliance with Ethical Standards


Ms Caitlin Stafford, Dr. Todd Francone, Dr. Patricia L. Roberts, and Dr. Rocco Ricciaridi have no conflicts of interest or financial ties to disclose.


  1. 1.
    CDC-Center for Disease Control and Prevention (n.d.). Accessed 24 Feb 2017
  2. 2.
    Raebel M, Newcomer S, Reifler L, Newcomer S, Reifler L, Boudreau D, Elliot T, DeBar L, Ahmed A, Pawloski P, Fisher D, Donahoo T, Bayliss E (2013) Chronic use of opioids medication before and after bariatric surgery. JAMA 13:1369–1376CrossRefGoogle Scholar
  3. 3.
    Jiang X, Orton M, Feng R, Hossain E, Malhotra NR, Zager E, Liu R (2016) Chronic opioid usage in surgical patients in a large academic center. Ann Surg 265(4):722–727CrossRefGoogle Scholar
  4. 4.
    Lloyd G, Kirby R, Heminigway F, Keane F, Miller S, Neary P (2010) The RAPID protocol enhances patient recovery after both laparoscopic and open colorectal resections. Surg Endosc 24:1434–1439CrossRefPubMedGoogle Scholar
  5. 5.
    White P, Kehlet H (2010) Improving postoperative pain management, what are the unresolved issues? Anesthesiology 112:220–225CrossRefPubMedGoogle Scholar
  6. 6.
    Johnson S, Chung K, Zhong L (2016) Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures. J Hand Surg Am 41:947–957CrossRefPubMedGoogle Scholar
  7. 7.
    Maheshwari K, Cummings KC, Farag E, Makarova N, Turan A, Kurz A (2016) A temporal analysis of opioid use, patients satisfaction, and pain scores in colorectal surgery patients. J Clin Anesth 34:661–667CrossRefPubMedGoogle Scholar
  8. 8.
    NSQIP (2005) National surgival improvement program. American College of Surgeons, ChicagoGoogle Scholar
  9. 9.
    Carrow I, Barelka P, Wang C (2012) A pilot cohort of the determinants of longitudina opioid use after surgery. Pain Med 3:694–702Google Scholar
  10. 10.
    Carroll I, Angst M, Clark D (2004) Management of perioperative pain in patients chronically consuming opioids. Reg Anesth Pain Med 6:576–591CrossRefGoogle Scholar
  11. 11.
    Clark H, Soneji N, Ko T, Yun D, Wijeysundera L D (2014) Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. PubMedCrossRefGoogle Scholar
  12. 12.
    Kehlet H, Jensen T, Woolf C (2006) Persistent postsurgical pain: risk factor and prevention. Lancet 367:1618–1625CrossRefPubMedGoogle Scholar
  13. 13.
    Katz J, Seltzer Z (2009) Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother 5:723–744CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Colon and Rectal Surgery, Division of General and Gastrointestinal SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Department of Colon and Rectal SurgeryLahey Hospital & Medical CenterBurlingtonUSA

Personalised recommendations