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Association ‘Between Gabapentinoids on the Day of Colorectal Surgery and Adverse Postoperative Respiratory Outcomes

Ohnuma, Tetsu MD, MPH*,†; Krishnamoorthy, Vijay MD, MPH, PhD; Ellis, Alan R. PhD, MSW; Yan, Rosalie MD; Ray, Neil D. MD, MMCi; Hsia, Hung-Lun MD; Pyati, Srinivas MBBS, MD, FCARCSI; Stefan, Mihaela MD, PhD§; Bryan, William E. PharmD*; Pepin, Marc J. PharmD*; Lindenauer, Peter K. MD, MSc§,¶; Bartz, Raquel R. MD; Raghunathan, Karthik MBBS, MPH*,†

doi: 10.1097/SLA.0000000000003317
LETTER-BRIEF CLINICAL REPORTS
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Objective: The aim of this study was to determine the association between gabapentinoids on the day of surgery and adverse postoperative outcomes in patients undergoing colorectal surgery in the United States.

Background: Gabapentinoids, gabapentin and pregabalin, are recommended in multimodal analgesia protocols for acute postoperative pain management after colorectal surgery. However, current literature focuses on the efficacy in reducing opioid consumption, but provides limited information about adverse risks.

Methods: This was a retrospective study including 175,787 patients undergoing elective colorectal surgery using the Premier database between 2009 and 2014. Multilevel regression models measured associations of receipt of gabapentinoids with naloxone use after surgery, non-invasive ventilation (NIV), invasive ventilation (IMV), hospital length of stay (LOS), and parental morphine equivalents (PMEs) on the day of surgery and on the day before discharge.

Results: Overall, 4677 (2.7%) patients received gabapentinoids on the day of surgery, with use doubling (1.7% in 2009 to 4.3% in 2014). Compared with patients who were unexposed to ganapentinoids, gabapentinoid exposure was associated with lower PMEs on the day of surgery [−2.7 mg; 95% confidence interval (CI), −5.2 to −0.0 mg], and with higher odds of NIV [odds ratio (OR) 1.22, 95% CI, 1.00–1.49] and receipt of naloxone (OR 1.58, 95% CI, 1.11–2.26). There was no difference between the groups with respect to IMV or PMEs on the day before discharge.

Conclusions: Although use of gabapentinoids on the day of surgery was associated with slightly lower PMEs on the day of surgery, it was associated with higher odds of NIV and naloxone use after surgery.

*Patient Safety Center of Inquiry, Durham VA Medical Center, Durham, NC

Department of Anesthesiology, Duke University Medical Center, Durham, NC

Department of Social Work, North Carolina State University, Raleigh, NC

§Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA

Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.

Reprints: Vijay Krishnamoorthy, MD, MPH, PhD, Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710. E-mail: vijay.krishnamoorthy@duke.edu.

Authors’ contributions: TO participated in study design, conduct of analyses, interpretation of data, writing of the manuscript, and final approval of the version to be published. SP participated in study design, revision of the article for intellectual content, and final approval of the version to be published. NDR participated in study design, revision of the article for intellectual content, and final approval of the version to be published. ARE participated in study design, conduct of analyses, interpretation of data, revision of the article for intellectual content, and final approval of the version to be published. MS participated in study design, revision of the article for intellectual content, and final approval of the version to be published. PKL participated in study design, revision of the article for intellectual content, and final approval of the version to be published. RY participated in study design, revision of the article for intellectual content, and final approval of the version to be published. H-LH participated in study design, revision of the article for intellectual content, and final approval of the version to be published. RRB participated in study design, revision of the article for intellectual content, and final approval of the version to be published. WEB participated in study design, revision of the article for intellectual content, and final approval of the version to be published.

MJP participated in study design, revision of the article for intellectual content, and final approval of the version to be published. KR led the study team, data analysis and interpretation, writing of the manuscript, and final approval of version to be published. VK participated in study design, interpretation of data, writing of the manuscript, and final approval of the version to be published.

This work was funded by the VA National Center for Patient Safety, Field Office 10A4E via the Patient Safety Center of Inquiry grant awarded in 2016 (PI: KR). The contents represent the views of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs or the United States Government.

The authors report no conflicts of interest.

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