Key result
Preoperative use of opioids (16% vs 7.9%), benzodiazepines (14% vs 8.3%), or both (20% vs 7.5%) significantly increased 30-day serious morbidity compared to naïve patients (p<0.001).
Why the study?
Preoperative opioid use is associated with worse surgical outcomes, but little is known about the effect of preoperative benzodiazepines with and without opioids.
Does preoperative opioid and/or benzodiazepine use increase 30-day morbidity in patients undergoing abdominal surgery?
Cohort (n=4,439)
Yes
Does preoperative opioid and/or benzodiazepine use increase 30-day morbidity in patients undergoing abdominal surgery?
Preoperative use of opioids and benzodiazepines, especially in combination, is an independent risk factor for increased 30-day postoperative morbidity in patients undergoing abdominal surgery.
Answers are grounded in this paper and cite their sources.
Preoperative opioid or benzodiazepine use identifies higher-risk abdominal surgery patients; confirms independent association but leaves open whether cessation improves outcomes.
BACKGROUND: Preoperative opioid use has shown association with worse outcomes after surgery. However, little is known about the effect of preoperative benzodiazepines with and without opioids. The aim of this study was to determine the influence of preoperative substance use on outcomes after abdominal surgery. STUDY DESIGN: Patients undergoing abdominal operations including ventral hernia, colectomy, hysterectomy, cholecystectomy, appendectomy, nephrectomy, and hiatal hernia were identified in an opioid surgical steward program by a regional NSQIP consortium between 2019 and 2021. American College of Surgeons NSQIP data were linked with custom substance use variables created by the collaborative. Univariable and multivariable analyses were performed for 30-day outcomes. RESULTS: Of 4,439 patients, 64% (n = 2,847) were women, with a median age of 56 years. The most common operations performed were hysterectomy (22%), ventral hernia repair (22%), and colectomy (21%). Preoperative opioid use was present in 11% of patients (n = 472), 10% (n = 449) were on benzodiazepines, and 2.3% (n = 104) were on both. Serious morbidity was significantly (p < 0.001) increased in patients on preoperative opioids (16% vs 7.9%) and benzodiazepines (14% vs 8.3%) compared with their naïve counterpart and this effect was amplified in patients on both substances (20% vs 7.5%). Multivariable regression analyses reveal that preoperative substance use is an independent risk factor (p < 0.01) for overall morbidity and serious morbidity. CONCLUSIONS: Preoperative opioid and benzodiazepine use are independent risk factors that contribute to postoperative morbidity. This influence on surgical outcomes is exacerbated when patients are on both substances.
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Fagenson et al. (2023) conducted a cohort in Abdominal surgery (n=4,439). Preoperative opioid and/or benzodiazepine use vs. Naïve counterpart (no preoperative substance use) was evaluated on 30-day serious morbidity (p=<0.001). Preoperative use of opioids (16% vs 7.9%), benzodiazepines (14% vs 8.3%), or both (20% vs 7.5%) significantly increased 30-day serious morbidity compared to naïve patients (p<0.001).
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