Fifty-one percent of patients undergoing elective colorectal surgery managed postdischarge pain without using any opioids, according to a recent study.

In a prospective cohort study of adults undergoing elective colorectal surgery, researchers assessed how patients managed pain after discharge, comparing real-world opioid use with routine postdischarge prescribing practices. Among 344 patients followed for 30 days, 51% reported opioid-free analgesia, with comparable rates after open surgery (47%), laparoscopic surgery (51%), and procedures performed via a stoma (52%). Older age, fewer opioid pills prescribed at discharge, no postdischarge cannabis use, and higher patient activation were associated with opioid-free analgesia.

Researchers performed a secondary analysis of a multicenter prospective cohort study enrolling adults aged 18 years or older who underwent elective colorectal procedures at two Canadian academic hospitals between March 2021 and September 2022. Participants self-reported analgesic consumption weekly for 1 month after discharge using a standardized survey capturing medication type and quantity, as well as nonpharmacological therapies and cannabis use. The primary outcome was opioid-free analgesia, defined as no opioid consumption within 30 days after discharge.

The cohort had a mean age of 58 years, 53% were male, and 65% underwent laparoscopic procedures. Most patients were opioid-naïve prior to surgery, and the median hospital length of stay was 3 days. Discharge prescriptions were predominantly multimodal: 92% of patients received acetaminophen, 38% received nonsteroidal anti-inflammatory drugs, and 92% were prescribed opioids for breakthrough pain, most commonly oxycodone or hydromorphone. The median number of opioid pills prescribed at discharge was 13.

To identify predictors of opioid-free analgesia, researchers used Bayesian model averaging, which evaluates multiple plausible regression models and accounts for model uncertainty. Older age was associated with opioid-free analgesia. Each additional opioid pill prescribed at discharge was associated with lower odds of remaining opioid free. Patients who did not use cannabis after discharge were more likely to avoid opioids, and higher patient activation showed a weaker positive association. "Our results suggest that addressing modifiable predictors of opioid consumption, including patient activation and prescription size, through prescriber stewardship and patient education may help minimize unnecessary opioid use and potentially mitigate opioid-related harms," noted lead study author Makena Pook, BHSc, of McGill University in Montreal, Canada, and colleagues.

There were several limitations in the study. Analgesic and cannabis use were self-reported, introducing potential recall bias and underreporting. The observational, post hoc design limits causal inference. Data on preoperative cannabis use and dosing were not collected, and cannabis use was infrequent. Pain management counseling and prescribing practices were not standardized across sites, and opioid-related adverse events were not assessed.

The researchers reported no conflicts of interest. The study was supported by funding from the Canadian Institutes of Health Research and the Fonds de recherche du Québec-Santé.

Source: Surgery