A study presented during the American College of Surgeons 2022 Clinical Congress in San Diego examined outcomes of patients taking opioids and/or benzodiazepines preoperatively, including postoperative morbidity and prolonged length of stay.

An analysis of data from 10 Pennsylvania NSQIP (National Surgical Quality Improvement Program) Consortium hospitals included a total of 1655 patients, with a median age of 56 years (61% female). Surgeries were ventral hernia (29%), colectomy (25%), hysterectomy, cholecystectomy, appendectomy, nephrectomy, and hiatal hernia, and were identified in the Pennsylvania Opioid Surgical Stewardship Enterprise, an NSQIP collaborative. Preoperative opioid use was identified in 13%, whereas 8.2% of patients were on benzodiazepines and 2.5% took both medications.

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

Readmission rates doubled when patients were taking a single substance, and 3 times higher when patients were on both opioids and benzodiazepines preoperatively. (Adapted from a report by Ethan Cove, Anesthesiology News, March 4, 2023.)