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Original Investigation |

Association of Preoperative Narcotic Use With Postoperative Complications and Prolonged Length of Hospital Stay in Patients With Crohn Disease

Yi Li, MD, PhD1; Luca Stocchi, MD1; Deepa Cherla, MD1; Xiaobo Liu, MS2; Feza H. Remzi, MD1
[+] Author Affiliations
1Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
2Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
JAMA Surg. 2016;151(8):726-734. doi:10.1001/jamasurg.2015.5558.
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Importance  The use of narcotics among patients with Crohn disease (CD) is endemic.

Objective  To evaluate the association between preoperative use of narcotics and postoperative outcomes in patients with CD.

Design, Setting, and Participants  Patients undergoing abdominal surgery for CD at a tertiary referral center between January 1998 and June 2014 were identified from an institutional prospectively maintained CD database.

Main Outcomes and Measures  Primary end points were overall morbidity, postoperative hospital length of stay, and readmission. Univariate and multivariate analyses were used to assess possible associations between postoperative outcomes and demographic and clinical variables, including preoperative narcotic use.

Results  Of the 1331 patients included, the mean age for patients who had at least 1 pharmacy claim for narcotics within 1 month before surgery was 41.5 years and 41.1 years for patients without a pharmacy claim. Of 1461 abdominal operations for CD, 267 (18.3%) were performed on patients receiving preoperative narcotics. Patients receiving narcotics were more likely to have a current smoking habit (P < .001) with perianal disease (P = .046) and undergoing treatment with biologics (P = .04). Patients with preoperative narcotic use had a longer mean (SD) length of stay (11.2 [8.9] vs 7.7 [5.5]; P < .001) and were more likely to develop postoperative complications (52.8% vs 40.8%; P < .001). Multivariable analysis indicated that preoperative narcotic use was the only independent risk factor associated with both postoperative morbidity (odds ratio = 1.36; 95% CI = 1.02-1.82; P = .04) and prolonged hospital stay (estimate = 2.91; SE = 0.44; P < .001). Subgroup analysis indicated that outpatient narcotic users had increased incidence of adverse postoperative outcomes compared with inpatient-only narcotic users.

Conclusions and Relevance  Preoperative use of narcotics in patients undergoing abdominal surgery for CD is associated with worse postoperative outcomes. Before starting regular narcotic use, patients with CD should be considered for surgical intervention.

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