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Inpatient administration of opioids and risk for post-operative ileus in older adults

Rosa Rodriguez-Monguio, PhD, MS, Ellen Berkley, PharmD, Edgardo Mendoza, PharmD, Kirsten Miller, PharmD, Shafat Selim, PharmD, Cindy Trac, PharmD, Zhixin Lun, PhD, Lori Reisner, PharmD, FCSHP

Abstract


Objective: Post-operative ileus (POI) is a common and potentially serious complication after surgery. We assessed the incidence and identified predictors of POI in older surgical patients.

Design: A retrospective observational study.

Setting: University of California-San Francisco electronic medical record data.

Participants: Opioid-naïve, noncancer patients, aged 65 and older, who underwent elective surgery in the period 2017-2019.

Exposure: Administration of opioid analgesics per day of hospitalization in opioid naïve patients.

Main outcomes measure: Incidence of POI and likelihood of developing POI.

Results: In the study period, 3 percent of opioid naïve patients developed POI. Patients with POI used on average 197.1 oral morphine equivalents (OMEs) per day of hospitalization compared to 82.5 OME in patients without POI (p = 0.013). Yet, there were not statistically significant differences in post-operative pain scores between patients with and without POI. General surgery (p = 0.0031), length of surgery (p = 0.0031), and hospital length of stay (p < 0.0001) were significant predictors of the risk for developing POI. Adjusted inpatient administration of more than 90 OME per day of hospitalization was associated with a four times greater risk for developing POI (p = 0.016). Developing POI was associated with 6.5 (95 percent confidence interval: 5.2-7.8) additional days of hospitalization among patients who developed POI compared to patients who did not develop POI (p < 0.0001).

Conclusions: Adjusted inpatient administration of more than 90 OME significantly increased the risk for developing POI in opioid-naïve older patients. Developing POI after surgery significantly increased the hospital length of stay. Optimizing inpatient administration of opioids may prevent opioid use-related POI and longer hospitalizations.


Keywords


opioid analgesics, post-operative complications, ileus, opioid-related adverse events, clinical outcomes

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References


Marderstein EL, Delaney CP: Management of postoperative ileus: Focus on alvimopan. Ther Clin Risk Manag. 2008; 4(5): 965-973. DOI: 10.2147/tcrm.s3147.

Baig MK, Wexner SD: Postoperative ileus: A review. Dis Colon Rectum. 2004; 47(4): 516-526. DOI: 10.1007/s10350-003-0067-9.

Funder JA, Tolstrup R, Jepsen BN, et al.: Postoperative paralytic ileus remains a problem following surgery for advanced pelvic cancers. J Surg Res. 2017; 218: 167-173. DOI: 10.1016/j.jss.2017.05.044.

Park SC, Chang SY, Mok S, et al.: Risk factors for postoperative ileus after oblique lateral interbody fusion: A multivariate analysis. Spine J. 2020; S1529-9430(20): 31139-31136. DOI: 10.1016/j.spinee.2020.10.002.

Gifford C, Minnema AJ, Baum J, et al.: Development of a postoperative ileus risk assessment scale: Identification of intraoperative opioid exposure as a significant predictor after spinal surgery. J Neurosurg. 2019; DOI: 10.3171/2019.5.SPINE19365.

Vather R, Bissett IP: Risk factors for the development of prolonged post-operative ileus following elective colorectal surgery. Int J Colorectal Dis. 2013; 28(10): 1385-1391. DOI: 10.1007/s00384-013-1704-y.

Moghadamyeghaneh Z, Hwang GS, Hanna MH, et al.: Risk factors for prolonged ileus following colon surgery. Surg Endosc. 2016; 30(2): 603-609. DOI: 10.1007/s00464-015-4247-1.

Iyer S, Saunders WB, Stemkowski S: Economic burden of postoperative ileus associated with colectomy in the United States. J Managed Care Specialty Pharmacy. 2009; 15(6): 485-494. DOI: 10.18553/jmcp.2009.15.6.485.

Nazzani S, Bandini M, Preisser F, et al.: Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis. Surg Oncol. 2019; 28: 201-207. DOI: 10.1016/j.suronc.2019.01.011.

Tu CP, Tsai CH, Tsai CC, et al.: Postoperative ileus in the elderly. Int J Gerontol. 2014; 8(1): 1-5. DOI: 10.1016/j.ijge.2013.08.002.

Goettsch WG, Sukel MP, van der Peet DL, et al.: In-hospital use of opioids increases rate of coded postoperative paralytic ileus. Pharmacoepidem Drug Safe. 2007; 16(6): 668-674. DOI: 10.1002/pds.1338.

Becker G, Blum HE: Novel opioid antagonists for opioid-induced bowel dysfunction and postoperative ileus. Lancet. 2009; 373(9670): 1198-1206. DOI: 10.1016/S0140-6736(09)60139-2.

Leslie JB, Viscusi ER, Pergolizzi JV Jr, et al.: Anesthetic routines: The anesthesiologist's role in GI recovery and postoperative ileus. Adv Preventive Med. 2011; 2011: E976904-E976910. DOI: 10.4061/2011/976904.

Chau DL, Walker V, Pai L, et al.: Opiates and elderly: Use and side effects. Clin Intervent Aging. 2008; 3(2): 273-278. DOI: 10.2147/cia.s1847.

Daniels AH, Ritterman SA, Rubin LE: Paralytic ileus in the orthopaedic patient. J Am Acad Orthopaedic Surg. 2015; 23(6): 365-372. DOI: 10.5435/JAAOS-D-14-00162.

Liu M, Wittbrodt E: Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manag. 2002; 23(1): 48-53. DOI: 10.1016/s0885-3924(01)00369-4.

Harnsberger CR, Maykel JA, Alavi K: Postoperative ileus. Clin Colon Rectal Surg. 2019; 32(3): 166-170. DOI: 10.1055/s-0038-1677003.

Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42(2): 377-381. DOI: 10.1016/j.jbi.2008.08.010.

University of California San Francisco Pain Management Committee: Opioid equivalent algorithm. 2018. Available at http://links.lww.com/ALN/B738. Accessed November 18, 2020.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65(No. RR-1): 1-49. DOI: 10.15585/mmwr.rr6501e1.

Grass F, Slieker J, Jurt J, et al.: Postoperative ileus in an enhanced recovery pathway—A retrospective cohort study. Int J Colorectal Dis. 2017; 32(5): 675-681. DOI: 10.1007/s00384-017-2789-5.

Vather R, Josephson R, Jaung R, et al.: Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: A prospective risk factor analysis. Surgery. 2015; 157(4): 764-773. DOI: 10.1016/j.surg.2014.12.005.

Budnitz DS, Lovegrove MC, Shehab N, et al.: Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011; 365(21): 2002-2012. DOI: 10.1056/NEJMsa1103053.

Miller M, Stürmer T, Azrael D, et al.: Opioid analgesics and the risk of fractures in older adults with arthritis. J Am Geriatr Soc. 2011; 59(3): 430-438. DOI: 10.1111/j.1532-5415.2011.03318.x.

Saunders KW, Dunn KM, Merrill JO, et al.: Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med. 2010; 25(4): 310-315. DOI: 10.1007/s11606-009-1218-z.

Puustinen J, Nurminen J, Löppönen M, et al.: Use of CNS medications and cognitive decline in the aged: A longitudinal population-based study. BMC Geriatr. 2011; 11: 70. DOI: 10.1186/1471-2318-11-70.

Venara A, Neunlist M, Slim K, et al.: Postoperative ileus: Pathophysiology, incidence, and prevention. J Visceral Surg. 2016; 153(6): 439-446. DOI: 10.1016/j.jviscsurg.2016.08.010.

Goldstein JL, Matuszewski KA, Delaney CP, et al.: Inpatient economic burden of postoperative ileus associated with abdominal surgery in the United States. Pharmacy Therapeut. 2007; 32(2): 82-90.

Centers for Medicare & Medicaid Services: Office of enterprise data and analytics. CMS Chronic Conditions Data Warehouse. 2018. Available at https://www.cms.gov/researchstatistics-data-systems/cms-program-statistics/2018-medicare-utilization-and-payment#MU1 . Accessed November 18, 2020.

Asgeirsson T, El-Badawi KI, Mahmood A, et al.: Postoperative ileus: It costs more than you expect. J Am College Surg. 2010; 210(2): 228-231. DOI: 10.1016/j.jamcollsurg.2009.09.028.

Doorly MG, Senagore AJ: Pathogenesis and clinical and economic consequences of postoperative ileus. Surg Clin North Am. 2012; 92(2): 259-272. DOI: 10.1016/j.suc.2012.01.010.




DOI: https://doi.org/10.5055/jom.2022.0727

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