More Opioids Associated with Persistent Postoperative Opioid Use in Crohn’s Disease

Abstract

INTRODUCTION: Up to 70% of patients with Crohn’s Disease (CD) experience debilitating abdominal pain during flares and often live with chronic abdominal pain. Furthermore, ~70% will require at least 1 operation during their disease course, with 50% of patients requiring multiple operations. Between 13% and 50% of adults with inflammatory bowel disease (IBD) chronically use opioids to manage pain. Surgery poses challenges for management of both chronic abdominal pain and acute postoperative pain in patients with IBD. Despite being a high-risk group, there are limited studies investigating prescribing patterns and the clinical impact of postoperative opioid use in CD. METHODS: The study population consisted of 357 patients with CD who underwent disease-related major abdominal operation between January 2014 and December 2018. Persistent opioid use was defined as either: 1) visit to outpatient pain service within 1 year; or 2) continued opioid use within 1 year after operation. RESULTS: Of the patients studied, 56 (15.7%) patients had persistent postoperative opioid use and 301 (84.3%) patients did not. Patients with persistent opioid use were prescribed significantly (p < 0.0001) higher total morphine milligram equivalents (240.0 MME) on hospital discharge postoperatively compared with patients who did not have persistent use (225.0 MME). There was no significant difference in history of previous major abdominal operation, length of stay, laparoscopic vs open approach, or procedure between patients who did and did not have persistent use (Table). CONCLUSION: Patients with CD who are prescribed more opioids after disease-related major abdominal operation are more likely to have persistent opioid use within 1 year postoperatively. Table. - Patient Population Characteristics Characteristic Persistent use (n = 56) No persistent use (n = 301) p Value Sex, f, (%) 27 (48.2%) 126 (41.9%) 0.38 Age (years), median (range) 39 (30, 50.5) 34 (27, 47) 0.06 BMI (kg/m2), median (range) 21.8 (19.4, 25.0) 21.2 (18.6, 24.9) 0.42 Alcohol/Smoker/Drug Use, n (%) 8 (14.3%) 38 (12.6%) 0.67 Public Insurance, n (%) 4 (7.1%) 24 (8.0%) 1.00 History of 1+ prior abdominal surgeries, n (%) 14 (25.0%) 72 (24.0%) 0.87 Length of Stay (days), median (range) 6 (5, 9) 6 (4, 8) 0.20 Laparoscopic (vs Open) Approach, n (%) 50 (89.3%) 274 (91.0%) 0.62 Total MME Prescribed, median (range) 240.0 (225.0, 570.0) 225.0 (157.5, 240.0) <.0001