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Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite advances in enhanced surgical recovery programs, strategies limiting postoperative inpatient opioid exposure have not been optimized for pancreatic surgery. The primary aims of this study were to analyze the magnitude and variations in post-pancreatectomy opioid administration and to characterize predictors of low and high inpatient use.

Methods

Clinical characteristics and inpatient oral morphine equivalents (OMEs) were downloaded from electronic records for consecutive pancreatectomy patients at a high-volume institution between March 2016 and August 2017. Regression analyses identified predictors of total OMEs as well as highest and lowest quartiles.

Results

Pancreatectomy was performed for 158 patients (73% pancreaticoduodenectomy). Transversus abdominus plane (TAP) block was performed for 80% (n = 127) of these patients, almost always paired with intravenous patient-controlled analgesia (IV-PCA), whereas 15% received epidural alone. All the patients received scheduled non-opioid analgesics (median, 2). The median total OME administered was 423 mg (range 0–4362 mg). Higher total OME was associated with preoperative opioid prescriptions (p < 0.001), longer hospital length of stay (LOS; p < 0.001), and no epidural (p = 0.006). The lowest and best quartile cutoff was 180 mg of OME or less, whereas the highest and worst quartile cutoff began at 892.5 mg. After adjustment for inpatient team, only epidural use [odds ratio (OR) 0.3; p = 0.04] predicted lowest-quartile OME. Preoperative opioid prescriptions (OR 8.1; p < 0.001), longer operative time (OR 3.4; p = 0.05), and longer LOS (OR 1.1; p = 0.007) predicted highest-quartile OME.

Conclusions

Preoperative opioid prescriptions and longer LOS were associated with increased inpatient OME, whereas epidural use reduced inpatient OME. Understanding the predictors of inpatient opioid use and the variables predicting the lowest and highest quartiles can inform decision-making regarding preoperative counseling, regional anesthetic block choice, and novel inpatient opioid weaning strategies to reduce initial postoperative opioid exposure.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Timothy E. Newhook MD, Whitney L. Dewhurst MS, Timothy J. Vreeland MD, Morgan L. Bruno MS, Michael P. Kim MD, Thomas A. Aloia MD, Jean-Nicolas Vauthey MD, Jeffrey E. Lee MD, Matthew H. G. Katz MD & Ching-Wei D. Tzeng MD

  2. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Xuemei Wang MS

  3. Department of Anesthesiology and Perioperative Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Jose Soliz MD, B. Bryce Speer DO & Shannon Hancher-Hodges MD

  4. Department of Medication Management and Analytics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Chun Feng MA

Authors
  1. Timothy E. Newhook MD
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  2. Whitney L. Dewhurst MS
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  3. Timothy J. Vreeland MD
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Correspondence to Ching-Wei D. Tzeng MD.

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Newhook, T.E., Dewhurst, W.L., Vreeland, T.J. et al. Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients. Ann Surg Oncol 26, 3428–3435 (2019). https://doi.org/10.1245/s10434-019-07528-z

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  • DOI: https://doi.org/10.1245/s10434-019-07528-z

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