Narcotic-Dependent Patients Derive Equal Benefit from Enhanced Recovery

Abstract

Areas of the southeast United States have endemic levels of prescription drug use, diversion, and abuse. Because preoperative narcotics use is associated with increased surgical morbidity and increased readmission rates, there is a compelling need to categorize health outcomes of patients maintaining an active opioid prescription. The purpose of this study is to determine the health outcomes of preoperative narcotic users who undergo colorectal surgery within the enhanced recovery (ER) protocol, a set of multimodal interventions designed to reduce postoperative complications. Five hundred and five colorectal surgery patients were identified within the ER protocol at Carilion Clinic. Opioid dependence was defined as an active prescription for 30 days before surgery. Thirty-day outcome variables were defined by the National Surgical Quality Improvement Program. One hundred and one patients were identified as opioid dependent and 404 as opioid naïve. Groups were comparable in terms of age at surgery, mean body mass index, and presurgical physical classification. Groups fared similarly with regard to readmission (χ², P > 0.999), reoperation (χ², P = 0.869), and average length of stay [t(135) = 1.49, P = 0.137]. These preliminary data show that opioid-dependent patients derive benefit equal to opioid-naïve patients within the ER protocol.