Preoperative Opioids and Panniculectomy Outcomes
Michael A. Cheah, MD1,2, Robert Lesko, BS1, Samuel Sarmiento, MD, MBA, MPH1, Carisa M. Cooney, MPH1, Damon S. Cooney, MD, PHD1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2INOVA Fairfax Medical Campus, Falls Church, VA, USA.
The opioid epidemic has gained significant national attention recently and the medical community is becoming more aware of the abuse potential and deleterious effects of opioid use, especially in surgical patients. Panniculectomy is a common plastic surgery procedure with a wide range of opioid use before and after surgery. In this study, we sought to evaluate the prevalence of preoperative opioid use among panniculectomy patients, and evaluate its impact on postoperative outcomes including complications, length of stay (LOS), and operative time.
We performed a retrospective review of patients 18 years of age or older who underwent panniculectomy at the Johns Hopkins Hospitals between March 2010 and May 2017. Patient charts were reviewed for demographic data and preoperative opioid use. Postoperative complications and persistent postoperative opioid use were examined at 30 days, six months, and 1 year postoperatively. Preoperative opioid use was assessed using home medication lists from their initial surgical consultation. Pearson's chi squared test was used to assess factors associated with preoperative opioid use. Multivariate regression analysis was used to examine the association between opioid use and the risk of complications.
Of the 203 patients included in this study, 40 (19.7%) had documented preoperative opioid use. There were no significant associations between preoperative opioid use and age, BMI, race, gender, ASA class, or comorbidities. Preoperative opioid users spent on average two more days in the hospital (coef: 2.11, 95% CI 0.329-3.89; p=0.02) and approximately 75 more minutes in the operating room (coef: 75; 95% CI: 23.9-126; p<0.005). There was a statistically significant association between preoperative opioid use and complications within 30 days after surgery (OR: 2.89; 95% CI: 1.27 -6.61, p=0.01) and within 180d after surgery (OR: 3.91; 95% CI: 1.33-11.5, p=0.01).
Preoperative opioid use has been linked to worse postoperative outcomes in orthopedic and general surgery. This study suggests that preoperative opioid use is associated with increased odds of postoperative complications following panniculectomy within both 30 days and 180 days as well as longer lengths of stay and operative times. With these findings in mind, plastic surgeons should be aware of the potential consequences of preoperative opioid use and approach the issue with increased caution.
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