Impact of Narcotic Use on Requirement of Colectomy in Inpatients with Ulcerative Colitis

Abstract

Purpose: Narcotics have been commonly used to treat diarrhea and abdominal pain. The effect of narcotic use in the disease course of ulcerative colitis (UC) has not been studied. The aim of the study was to evaluate of the impact of narcotic use on the requirement of colectomy in inpatients with UC. Methods: All patients with UC admitted to GI service for disease flare-ups between 2002 and 2007 were included. Exclusion criteria: 1) patients with UC admitted to colorectal surgery service for emergent or elective colectomy; 2) patients with Crohn's disease. Demographic, clinical, and laboratory data were reviewed. The definition of narcotics use was oral or IV administration of the agents at the time of admission or hospital transfer. Proctocolectomy was defined as the operation performed during the current or subsequent hospitalization. Stepwise multivariable analysis was performed. Results: 105 patients were included. 23 (21.9%) patients were on oral or intravenous narcotics at the time of admission or hospital transfer. 38 (36.2%) patients had colectomy eventually. 53 were males. 30 (28.6%) patients were transferred from outside institution. 18 had colectomy during hospitalization and 20 had colectomy during subsequent hospitalization. There was no significant difference between patients with and without narcotic use regarding age, gender, disease extent, steroid use, hemoglobin, white blood cell count, platelet count, rate of readmission, and rate of colectomy (39.1% vs 35.4%, P= 0.11). On multivariate analysis, only steroid use remained in the model as an independent risk factor of predicting colectomy (Odds ratio, 2.412, 95% confidence interval, 1.235∼4.713, P= 0.016). Narcotic use was not an independent risk factor of colectomy in this study (P= 0.924). Conclusion: Narcotic use was common and was observed in 1/4 patients with UC who were admitted to GI service. However, the narcotic use appeared not to have an independently significant impact on the colectomy rate in inpatients with UC. In contrast, the requirement of steroid treatment was associated with an increased risk for colectomy.Table: Association between Variables and Colectomy-Multivariate Logistic Regression Model.