番茄社区

WASHINGTON -- Patients using opioids were significantly less likely to be adequately prepared for colonoscopy, and were more likely to suffer surgical complications, a study here showed.

Opioid users of either sex were 36% less likely to be prepared than non-users (OR 0.64, CI 0.50-0.82, P<0.001), reported epidemiologist Lois Lamerato, PhD, of Henry Ford Health System in Detroit, and colleagues.

"We don't want patients not to be prepared," said Lamerato. "It's a waste of resources."

These results, presented at , are important not only to save scarce resources, Lamerato said, but also because the study showed that patients exposed to opioids were more likely to suffer procedure-related complications even when they had adequate bowel prep (8 versus 1, P<0.01). Overall, those using opioids were more likely to suffer complications (1.6% versus 0.3% in non-users, P<0.01) and were less likely to report excellent or good bowel prep adequacy (87.3% versus 81.5%, P<0.001).

And men were 30% less likely than women to be prepared for colonoscopy, whether exposed to opioids or not (OR 0.70, CI 0.55-0.89, P<0.01).

While Lamerato briefly speculated on why men are less-often prepared (citing her husband's stubbornness as an example), she said researchers are more concerned about the findings regarding opioid users. This, she said, is a factor that can be addressed: "We have an opportunity to educate patients and providers."

Lamerato suggested opioid use be asked about during the colonoscopy screening process "to determine if any special handling should take place."

While colonoscopy is the most common colorectal cancer screening test in the U.S., "poor bowel preparation is a major impediment to the effectiveness of the procedure," the researchers noted.

"Colonoscopy presents an opportunity to educate on the impact of opioids on bowel function, provide adequate bowel prep to maximize quality of colonoscopy, and optimize bowel function for ongoing opioid therapy," they wrote.

Lamerato's group conducted the retrospective observational cohort study to examine opioid exposure's effect on preparation among colonoscopy patients, and consequences such as complications. As opioid exposure is a known risk factor for poor prep, "the objective of this investigation was to further explore the impact of opioid exposure on adequacy of colonoscopy prep," they wrote.

They examined 964 patients exposed to opioids and 1,054 who were unexposed.

Outpatient visit data from two medical centers were used, identifying adult colonoscopies conducted in 2015 and 2016 via Current Procedural Terminology edition 4 coding. They randomized their sample with a 1:1 ratio of opioid users and non-users.

Opioid users were classified as patients on the medications for more than 2 weeks during the 28-day pre-procedure period, based on prescriptions filled or ordered within 42 days of the procedure. Patients on buprenorphine, butorphanol or nalbuphine were excluded from the study. Electronic records were reviewed to confirm opioid use.

Patients 18-49 were the only age group that was more likely to have been exposed to opioids (58.3% versus 41.7%, P<0.001). Roughly half of black (50.9%), white (47.5%) and Hispanic (46.8%) patients had been exposed to opioids, compared with 22.9% of Asian patients and 37.3% for other/unknown races (P<0.001 for all). Gender did not significantly predict opioid exposure, and no significant preparation differences were seen between different age groups or ethnicities.

Comment