Rates and predictors of postdischarge opioid-free analgesia after elective colorectal surgery: A prospective cohort study.

Abstract

Opioids are widely prescribed after colorectal surgery but may cause adverse events, misuse, and addiction. Despite growing interest in opioid-free analgesia, the rate and characteristics of patients undergoing colorectal surgery who consume no opioids postdischarge remain uncertain. This study aimed to (1) estimate the rate of patients who consume no opioids postdischarge after colorectal surgery and (2) identify patient and care characteristics associated with opioid-free analgesia. This prospective cohort study enrolled adults (aged ≥18 years) undergoing elective colorectal surgery at 2 academic hospitals. Self-reported analgesic consumption was assessed weekly for 1 month postdischarge. Rates of opioid-free analgesia were analyzed descriptively. Predictors were identified using Bayesian model averaging, with higher posterior effect probability reflecting stronger association. A total of 344 participants were included (mean age: 58 ± 15 years; 54% male; 65% laparoscopic surgery; 31% rectal procedure; median hospital stay: 3 days [interquartile range: 1-5 days]). Discharge prescriptions included nonopioids (92% acetaminophen, 38% nonsteroidal anti-inflammatory drugs, and 2% gabapentinoids) and opioids (92%). At 30 days, 51% used no opioids postdischarge (47% after open surgery, 51% after laparoscopic surgery, 52% after procedures via stoma [ie, loop ostomy reversal]). Opioid-free analgesia was associated with older age (odds ratio: 1.04, posterior effect probability = 100%), fewer opioid pills prescribed (odds ratio: 0.92, posterior effect probability = 100%), no postdischarge cannabis use (odds ratio: 0.09, posterior effect probability = 96%), and high patient activation (ie, confidence for self-managing care; odds ratio: 2.20, posterior effect probability = 67%). Approximately half of patients undergoing colorectal surgery do not use opioids postdischarge. Older patients, those with higher patient activation, those who did not use cannabis, and those with fewer opioids prescribed were more likely to rely on opioid-free analgesia. Opioid-free postdischarge analgesia may be feasible after colorectal surgery and should be further investigated.