Statewide Utilization of Multimodal Analgesia and Length of Stay After Colectomy

J Surg Res. 2020 Mar;247:264-270. doi: 10.1016/j.jss.2019.10.014. Epub 2019 Nov 6.


Background: Both enhanced recovery and anesthesia literature recommend multimodal perioperative analgesia to hasten recovery, prevent adverse events, and reduce opioid use after surgery. However, adherence to, and outcomes of, these recommendations are unknown. We sought to characterize use of multimodal analgesia and its association with length of stay after colectomy.

Materials and methods: Within a statewide, 72-hospital collaborative quality initiative, we evaluated postoperative analgesia regimens among adult patients undergoing elective colectomy between 2012 and 2015. We used logistic regression to identify factors associated with the use of multimodal analgesia and performed multivariable linear regression to evaluate its association with postoperative length of stay (LOS).

Results: Among 7265 patients who underwent elective colectomy in the study period, 4660 (64.1%) received multimodal analgesia, 2405 (33.1%) received opioids alone, and 200 (2.8%) received one nonopioid pain medication alone. Multimodal analgesia was independently associated with shorter adjusted postoperative LOS, compared with opioids alone (5.60 d [95% CI 5.38-5.81] versus 5.96 d [5.68-6.24], P = 0.016).

Conclusions: Multimodal analgesia is associated with shorter LOS, yet one-third of patients statewide received opioids alone after colectomy. As surgeons increasingly focus on our role in the opioid crisis, particularly in postdischarge opioid prescribing, we must also focus on inpatient postoperative pain management to limit opioid exposure. At the hospital level, this may have the added benefit of decreasing LOS and hastening recovery.

Keywords: Analgesia; Colectomy; Enhanced recovery; Length of stay; Multimodal analgesia; Opioid.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesia / methods
  • Analgesia / statistics & numerical data*
  • Analgesics, Non-Narcotic / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Colectomy / adverse effects*
  • Drug Therapy, Combination
  • Elective Surgical Procedures / adverse effects*
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Michigan / epidemiology
  • Middle Aged
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology
  • Postoperative Period
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid