The Association Between Potential Opioid-Related Adverse Drug Events and Outcomes in Colorectal Surgery

J Laparoendosc Adv Surg Tech A. 2019 Nov;29(11):1436-1445. doi: 10.1089/lap.2019.0408. Epub 2019 Sep 26.


Introduction: Major colorectal surgery procedures are complex operations that can result in significant postoperative pain and complications. More evidence is needed to demonstrate how opioid-related adverse drug events (ORADEs) after colorectal surgery can affect hospital length of stay (LOS), hospital revenue, and what their association is with clinical conditions. By understanding the clinical and economic impact of potential ORADEs within colorectal surgery, we hope to further guide approaches to perioperative pain management in an effort to improve patient care and reduce hospital costs. Materials and Methods: We conducted a retrospective study utilizing the Centers for Medicare and Medicaid Services (CMS) Administrative Database to analyze Medicare discharges involving three colorectal surgery diagnosis-related groups (DRGs) to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed. Results: The potential ORADE rate in patients undergoing colorectal surgery was 23.92%. The mean LOS for discharges with a potential ORADE was 5.35 days longer than without an ORADE. The mean hospital revenue per day with a potential ORADE was $418 less than without an ORADE. Any type of open surgery had a statistically significant higher potential ORADE rate than the matched laparoscopic case (P < .001). Clinical conditions most strongly associated with ORADEs in colorectal surgery included septicemia, pneumonia, shock, and fluid and electrolyte disorders. Conclusion: The incidence of ORADEs in colorectal surgery is high and is associated with longer hospital stays and reduced hospital revenue. Reducing the use of opioids in the perioperative setting, such as using multimodal analgesia strategies, may lead to positive outcomes with shorter hospital stays, increased hospital revenue, and improved patient care.

Keywords: colorectal; complications; opioid; outcomes; respiratory; surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / adverse effects*
  • Colon / surgery
  • Databases, Factual
  • Digestive System Surgical Procedures / adverse effects
  • Digestive System Surgical Procedures / economics
  • Digestive System Surgical Procedures / statistics & numerical data*
  • Drug-Related Side Effects and Adverse Reactions
  • Female
  • Hospital Costs*
  • Humans
  • Incidence
  • Laparoscopy / adverse effects
  • Laparoscopy / economics
  • Laparoscopy / statistics & numerical data*
  • Length of Stay*
  • Male
  • Medicare / statistics & numerical data
  • Middle Aged
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / etiology
  • Pneumonia / epidemiology
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology*
  • Rectum / surgery
  • Retrospective Studies
  • Sepsis / epidemiology
  • Shock / epidemiology
  • Treatment Outcome
  • United States / epidemiology
  • Water-Electrolyte Imbalance / epidemiology


  • Analgesics, Opioid