SAN DIEGO—Patients undergoing abdominal surgery who took preoperative opioids and benzodiazepines had significantly increased postoperative morbidity and prolonged length of stay, according to data presented during the American College of Surgeons 2022 Clinical Congress.

“These patients represent a unique subset of the surgical population who exemplify an opportunity for improvement in surgical quality and outcomes,” said Alexander M. Fagenson, MD, a general surgeon at Temple University Hospital, in Philadelphia.

The analysis included data from 10 Pennsylvania NSQIP (National Surgical Quality Improvement Program) Consortium hospitals, and included a total of 1,655 patients, with a median age of 56 years, 61% of whom were female. The patients were undergoing ventral hernia repair, colectomy, hysterectomy, cholecystectomy, appendectomy, nephrectomy and hiatal hernia repair, and were identified in the Pennsylvania Opioid Surgical Stewardship Enterprise, an NSQIP collaborative.

The most common surgical procedures were ventral hernia repair, in 29% of patients, and colectomy at 25%. Rates of preoperative opioid use were 13%, while 8.2% of patients were on benzodiazepines and 2.5% were on both medications.

Compared with opioid-naive patients, those on opioids had higher rates of overall (18% vs. 8.3%) and serious (13% vs. 5%) morbidity. Patients on preoperative benzodiazepines, with and without opioids, had significantly increased operative time and length of stay. The association between morbidity and preoperative substance use was exacerbated when patients were on both substances.

Readmissions also were increased twofold when patients were taking a single substance, and threefold higher when patients were on both opioids and benzodiazepines preoperatively.

“This study was limited by 30-day outcomes and retrospective nature of the database,” Dr. Fagenson noted. In addition, he said, patients on preoperative opioids were not stratified based on oral morphine equivalents due to a small sample size, and subanalysis based on procedure type also was not performed due to the sample size.

“Future research will focus on these aforementioned topics,” he concluded.

—Ethan Covey