Current Literature

Preoperative Opioid and Benzodiazepine Use Raises Risk of Serious Postoperative Morbidity

Fagenson AM, Schleider C, Philp MM, et al. Preoperative Opioid and Benzodiazepine Use: Influence on Abdominal Surgical Outcomes. J Am Coll Surg. 2023, in press.

Previously published research has documented an association between preoperative opioid use and increased risk for postoperative morbidity in patients undergoing various operative procedures. This study used carefully matched patient data from the Pennsylvania National Surgical Quality Improvement Program database to determine the risk of morbidity at 30 days postoperatively associated with preoperative use of opioids and benzodiazepine (in combination) in patients undergoing abdominal surgery.

The study cohort consisted of 4,439 patients; women composed 64% of patients and median age was 56 years. The most common procedures were hysterectomy, ventral hernia repair, and colectomy. Preoperative opioid use was confirmed in 11% of patients, and 10% were using benzodiazepine; combined opioid and benzodiazepine use was documented in 2.3% of patients. When outcomes at 30 days postoperatively were compared between patients using benzodiazepine and opioids together and patients who were not using either drug, serious postoperative morbidity (surgical site infection, urinary tract infection, hospital readmission) was observed in 20% of patients using the drugs and 7.5% of patients who were not using the drugs.

The authors recommended dedicated efforts to discontinue opioid and benzodiazepine use prior to elective abdominal operations. They noted that protocols to reduce opioid use for postoperative pain control in orthopedic and colorectal surgery have been shown to be effective, and these approaches have the potential to reduce or eliminate preoperative opioid and benzodiazepine usage.

Prophylactic Mesh Placement during Formation of an End-Colostomy Reduces the Rate of Parastomal Hernia

Brandsma HT, Hansson BM, Aufenacker TJ, et al. Prophylactic Mesh Placement during Formation of an End-Colostomy Reduces the Rate of Parastomal Hernia: Short-term Results of the Dutch PREVENT-trial. Ann Surg. 2017;265(4):663-669.

This prospective superiority trial from multiple institutions in the Netherlands assessed the effectiveness of prophylactic mesh placement at the time of creation of a permanent colostomy as a means of preventing parastomal hernia. A total of 150 patients were randomly assigned to receive prophylactic mesh reinforcement of the colostomy site (n = 72) or conventional management (n = 78).

At the 60-month follow-up evaluation, 113 patients were available for analysis. The risk of parastomal hernia (diagnosed by computed tomography and graded with a standard scale) was not significantly different for both groups (27.8% for the mesh group and 37.2% for the non-mesh group). The time to diagnosis of parastomal hernia was significantly longer for patients in the mesh group. Operative time was 26 minutes longer for patients who had mesh placement but overall mortality, morbidity, hospital length of stay, and quality of life were similar for both comparison groups.

Assessment of cost effectiveness using standard tests confirmed that the use of mesh was cost effective. There were no documented mesh complications, and explantation of mesh was not needed in any of the patients available for long-term follow-up.

Although the conclusions of the study should be interpreted cautiously because 25% of the enrolled patients were not available for long-term follow-up, the data suggest that there is benefit and no increase in risk for morbidity or diminished quality of life when prophylactic mesh placement is used. The authors noted that prospective studies of the Sugarbaker mesh placement technique, the most used technique for repair of parastomal hernia, are needed to determine the value of this approach for prevention of parastomal hernia.