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19.07.2023 | Original Article

Postoperative Opioid Use Is Associated with Increased Rates of Grade B/C Pancreatic Fistula After Distal Pancreatectomy

verfasst von: Artem Boyev, Laura R. Prakash, Yi-Ju Chiang, Christopher P. Childers, Anish J. Jain, Timothy E. Newhook, Morgan L. Bruno, Elsa M. Arvide, Whitney L. Dewhurst, Michael P. Kim, Naruhiko Ikoma, Jeffrey E. Lee, Rebecca A. Snyder, Matthew H. G. Katz, Ching-Wei D. Tzeng, Jessica E. Maxwell

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 10/2023

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Abstract

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major source of morbidity after distal pancreatectomy. This study examined the association between postoperative opioid use and CR-POPF in the context of opioid-sparing postoperative care.

Methods

A case–control study was performed on consecutive patients who underwent distal pancreatectomy between October 2016 and April 2022 at a single institution. Patients who developed CR-POPF were compared to controls. Multivariable regression modeling was used to identify factors associated with CR-POPF.

Results

A total of 281 patients underwent 187 open, 20 laparoscopic, and 74 robotic-assisted operations. The rate of CR-POPF was 21% (n = 58). CR-POPF rate declined from 32 to 8% over the study period (p < 0.001). Median oral morphine equivalents (OME) administered on POD 0–1 and 0–3 were 94 and 129 mg, respectively, in patients who did not develop a fistula versus 130 and 180 mg in those who did (both p ≤ 0.001). POD 0–3 OME (OR 1.11, p = 0.044) was independently associated with increased odds of CR-POPF, with each additional 50 mg (equivalent to 10 tramadol pills) increasing the relative risk by 11% and absolute risk by 2%.

Conclusion

Early postoperative opioid use after distal pancreatectomy was associated with increased odds of CR-POPF. Decreasing perioperative opioid use through enhanced postoperative management is a low-cost and generalizable approach that may reduce rates of CR-POPF after distal pancreatectomy.

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Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161(3):584-91. https://doi.org/10.1016/j.surg.2016.11.014.CrossRefPubMed

Nassour I, AlMasri S, Hodges JC, Hughes SJ, Zureikat A, Paniccia A. Novel Calculator to Estimate the Risk of Clinically Relevant Postoperative Pancreatic Fistula Following Distal Pancreatectomy. J Gastrointest Surg. 2022;26(7):1436-44. https://doi.org/10.1007/s11605-022-05275-3.CrossRefPubMed

Pecorelli N, Guarneri G, Palucci M, Gozzini L, Vallorani A, Crippa S et al. Early biochemical predictors of clinically relevant pancreatic fistula after distal pancreatectomy: a role for serum amylase and C-reactive protein. Surg Endosc. 2022;36(7):5431-41. https://doi.org/10.1007/s00464-021-08883-3.CrossRefPubMed

Fukami Y, Saito T, Osawa T, Hanazawa T, Kurahashi T, Kurahashi S et al. Which is the best predictor of clinically relevant pancreatic fistula after pancreatectomy: drain fluid concentration or total amount of amylase? Ann Gastroenterol Surg. 2021;5(6):844-52. https://doi.org/10.1002/ags3.12471.CrossRefPubMedPubMedCentral

Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM, Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1-14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002.CrossRefPubMed

Miller BC, Christein JD, Behrman SW, Drebin JA, Pratt WB, Callery MP et al. A multi-institutional external validation of the fistula risk score for pancreatoduodenectomy. J Gastrointest Surg. 2014;18(1):172-79; discussion 9-80. https://doi.org/10.1007/s11605-013-2337-8.CrossRefPubMed

Peng YP, Zhu XL, Yin LD, Zhu Y, Wei JS, Wu JL et al. Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis. Sci Rep. 2017;7(1):185. https://doi.org/10.1038/s41598-017-00311-8.CrossRefPubMedPubMedCentral

Andrianello S, Marchegiani G, Bannone E, Vacca P, Esposito A, Casetti L et al. Predictors of pancreatic fistula healing time after distal pancreatectomy. J Hepatobiliary Pancreat Sci. 2021;28(12):1076-88. https://doi.org/10.1002/jhbp.843.CrossRefPubMed

Bag YM, Topel C, Ozdemir E, Saglam K, Sumer F, Kayaalp C. A Novel Radiological Predictor for Postoperative Pancreatic Fistula After Stapled Distal Pancreatectomy. Am Surg. 2021;87(5):725-31. https://doi.org/10.1177/0003134820952429.CrossRefPubMed

10.

Shen J, Zhang Y, Hu J, Wei R, Wu H. Albumin difference as a new predictor of pancreatic fistula following distal pancreatectomy: a retrospective study of 211 consecutive patients. Langenbecks Arch Surg. 2020;405(1):55-62. https://doi.org/10.1007/s00423-019-01849-z.CrossRefPubMed

11.

Zimmitti G, La Mendola R, Manzoni A, Sega V, Malerba V, Treppiedi E et al. Investigation of intraoperative factors associated with postoperative pancreatic fistula following laparoscopic left pancreatectomy with stapled closure: a video review-based analysis : Video-review for predictors of pancreatic leak. Surg Endosc. 2021;35(2):941-54. https://doi.org/10.1007/s00464-020-07912-x.CrossRefPubMed

12.

Halle-Smith JM, Vinuela E, Brown RM, Hodson J, Zia Z, Bramhall SR et al. A comparative study of risk factors for pancreatic fistula after pancreatoduodenectomy or distal pancreatectomy. HPB (Oxford). 2017;19(8):727-34. https://doi.org/10.1016/j.hpb.2017.04.013.CrossRefPubMed

13.

Ozyazici S, Erdogan O. Risk Factors of Postoperative Clinically Relevant Pancreatic Fistula following Distal Pancreatectomy with Stapler Closure. J Coll Physicians Surg Pak. 2021;31(10):1214-8. https://doi.org/10.29271/jcpsp.2021.10.1214.CrossRefPubMed

14.

Belyaev O, Munding J, Herzog T, Suelberg D, Tannapfel A, Schmidt WE et al. Histomorphological features of the pancreatic remnant as independent risk factors for postoperative pancreatic fistula: a matched-pairs analysis. Pancreatology. 2011;11(5):516-24. https://doi.org/10.1159/000332587.CrossRefPubMed

15.

Kowalsky SJ, Zenati MS, Dhir M, Schaefer EG, Dopsovic A, Lee KK et al. Postoperative narcotic use is associated with development of clinically relevant pancreatic fistulas after distal pancreatectomy. Surgery. 2018;163(4):747-52. https://doi.org/10.1016/j.surg.2017.10.042.CrossRefPubMed

16.

Igarashi T, Harimoto N, Matsui Y, Muranushi R, Yamanaka T, Hagiwara K et al. Association between intraoperative and postoperative epidural or intravenous patient-controlled analgesia and pancreatic fistula after distal pancreatectomy. Surg Today. 2021;51(2):276-84. https://doi.org/10.1007/s00595-020-02087-3.CrossRefPubMed

17.

Hashimoto Y, Traverso LW. After distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure. J Gastrointest Surg. 2012;16(5):993-1003. https://doi.org/10.1007/s11605-012-1849-y.CrossRefPubMed

18.

Fazel A, Geenen JE, MoezArdalan K, Catalano MF. Intrapancreatic ductal pressure in sphincter of Oddi dysfunction. Pancreas. 2005;30(4):359-62. https://doi.org/10.1097/01.mpa.0000160278.11086.89.CrossRefPubMed

19.

Helm JF VR, Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Arndorfer RC. Effects of morphine on the human sphicter of Oddi. Gut. 1988;29:1402-7.CrossRefPubMedPubMedCentral

20.

Newhook TE, Vreeland TJ, Dewhurst WL, Arvide EM, Bruno ML, Robinson KA et al. Opioid-prescribing Practices After Oncologic Surgery: Opportunities for Improvement and a Call to Action. Ann Surg. 2020;271(2):e9-e10. https://doi.org/10.1097/SLA.0000000000003595.CrossRefPubMed

21.

Newhook TE, Dewhurst WL, Vreeland TJ, Wang X, Soliz J, Speer BB et al. Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients. Ann Surg Oncol. 2019;26(11):3428-35. https://doi.org/10.1245/s10434-019-07528-z.CrossRefPubMed

22.

Newhook TE, Vreeland TJ, Dewhurst WL, Wang X, Prakash L, Feng C et al. Clinical Factors Associated With Practice Variation in Discharge Opioid Prescriptions After Pancreatectomy. Ann Surg. 2020;272(1):163-9. https://doi.org/10.1097/SLA.0000000000003112.CrossRefPubMed

23.

Kim BJ, Newhook TE, Blumenthaler A, Chiang YJ, Aloia TA, Roland CL et al. Sustained reduction in discharge opioid volumes through provider education: Results of 1168 cancer surgery patients over 2 years. J Surg Oncol. 2021;124(1):143-51. https://doi.org/10.1002/jso.26476.CrossRefPubMedPubMedCentral

24.

Witt RG, Newhook TE, Prakash LR, Bruno ML, Arvide EM, Dewhurst WL et al. Association of Patient Controlled Analgesia and Total Inpatient Opioid Use After Pancreatectomy. J Surg Res. 2022;275:244-51. https://doi.org/10.1016/j.jss.2022.02.031.CrossRefPubMedPubMedCentral

25.

Witt RG, Hirata Y, Prakash LR, Newhook TE, Maxwell JE, Kim MP et al. Comparative analysis of opioid use between robotic and open pancreatoduodenectomy. J Hepatobiliary Pancreat Sci. 2023;30(4):523-531. https://doi.org/10.1002/jhbp.1216.CrossRefPubMed

26.

Denbo JW, Bruno M, Dewhurst W, Kim MP, Tzeng CW, Aloia TA et al. Risk-stratified clinical pathways decrease the duration of hospitalization and costs of perioperative care after pancreatectomy. Surgery. 2018;164(3):424-31. https://doi.org/10.1016/j.surg.2018.04.014.CrossRefPubMed

27.

Denbo JW, Slack RS, Bruno M, Cloyd JM, Prakash L, Fleming JB et al. Selective Perioperative Administration of Pasireotide is More Cost-Effective Than Routine Administration for Pancreatic Fistula Prophylaxis. J Gastrointest Surg. 2017;21(4):636-46. https://doi.org/10.1007/s11605-016-3340-7.CrossRefPubMed

28.

Newton AD, Newhook TE, Bruno ML, Prakash L, Chiang YJ, Arango NP et al. Iterative Changes in Risk-Stratified Pancreatectomy Clinical Pathways and Accelerated Discharge After Pancreaticoduodenectomy. J Gastrointest Surg. 2022;26(5):1054-62. https://doi.org/10.1007/s11605-021-05235-3.CrossRefPubMed

29.

Ayabe RI PL, Bruno ML, Newhook TE, Maxwell JE, Arvide EM, Dewhurst WL et al. Differential Gains in Surgical Outcomes for High-Risk vs. Low-Risk Pancreatoduodenectomy with Successive Refinements of Risk-Stratified Care Pathways. J Am Coll Surg. 2023;237(1):4-12.https://doi.org/10.1097/XCS.0000000000000652.

30.

Newhook TE, Vega EA, Vreeland TJ, Prakash L, Dewhurst WL, Bruno ML et al. Early postoperative drain fluid amylase in risk-stratified patients promotes tailored post-pancreatectomy drain management and potential for accelerated discharge. Surgery. 2020;167(2):442-7. https://doi.org/10.1016/j.surg.2019.09.015.CrossRefPubMed

31.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. https://doi.org/10.1016/S0140-6736(07)61602-X.CrossRef

32.

The University of Texas MD Anderson Cancer Center, Department of Clinical Effectiveness. Cancer pain- Adult clinical practice algorithm, Version 12, 2020. https://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/clinical-management/clin-management-cancer-pain-web-algorithm.pdf. Accessed 18 Oct 2022.

33.

Patanwala AE, Duby J, Waters D, Erstad BL. Opioid conversions in acute care. Ann Pharmacother. 2007;41(2):255-66. https://doi.org/10.1345/aph.1H421.CrossRefPubMed

34.

Anderson R, Saiers JH, Abram S, Schlicht C. Accuracy in equianalgesic dosing. conversion dilemmas. J Pain Symptom Manage. 2001;21(5):397-406. https://doi.org/10.1016/s0885-3924(01)00271-8.CrossRefPubMed

35.

Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001;22(2):672-87. https://doi.org/10.1016/s0885-3924(01)00294-9.CrossRefPubMed

36.

Ecker BL, McMillan MT, Allegrini V, Bassi C, Beane JD, Beckman RM et al. Risk Factors and Mitigation Strategies for Pancreatic Fistula After Distal Pancreatectomy: Analysis of 2026 Resections From the International, Multi-institutional Distal Pancreatectomy Study Group. Ann Surg. 2019;269(1):143-9. https://doi.org/10.1097/SLA.0000000000002491.CrossRefPubMed

37.

Miao Y, Lu Z, Yeo CJ, Vollmer CM, Jr., Fernandez-Del Castillo C, Ghaneh P et al. Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2020;168(1):72-84. https://doi.org/10.1016/j.surg.2020.02.018.CrossRefPubMed

38.

Sa Cunha A, Carrere N, Meunier B, Fabre JM, Sauvanet A, Pessaux P et al. Stump closure reinforcement with absorbable fibrin collagen sealant sponge (TachoSil) does not prevent pancreatic fistula after distal pancreatectomy: the FIABLE multicenter controlled randomized study. Am J Surg. 2015;210(4):739-48. https://doi.org/10.1016/j.amjsurg.2015.04.015.CrossRefPubMed

39.

Weniger M, D'Haese JG, Crispin A, Angele MK, Werner J, Hartwig W. Autologous but not Fibrin Sealant Patches for Stump Coverage Reduce Clinically Relevant Pancreatic Fistula in Distal Pancreatectomy: A Systematic Review and Meta-analysis. World J Surg. 2016;40(11):2771-81. https://doi.org/10.1007/s00268-016-3612-0.CrossRefPubMed

40.

Mungroop TH, van der Heijde N, Busch OR, de Hingh IH, Scheepers JJ, Dijkgraaf MG et al. Randomized clinical trial and meta-analysis of the impact of a fibrin sealant patch on pancreatic fistula after distal pancreatectomy: CPR trial. BJS Open. 2021;5(3):zrab001. https://doi.org/10.1093/bjsopen/zrab001.

41.

Luu AM, Braumann C, Uhl W, Janot-Matuschek M, Herzog T. Does autologous fibrin sealant (vivostat((c))) reduce the incidence of postoperative pancreatic fistula after distal pancreatectomy? - a matched pairs analysis. Acta Chir Belg. 2021;121(1):16-22. https://doi.org/10.1080/00015458.2019.1658354.CrossRefPubMed

42.

Deng Y, He S, Cheng Y, Cheng N, Gong J, Gong J et al. Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery. Cochrane Database Syst Rev. 2020;3:CD009621. https://doi.org/10.1002/14651858.CD009621.pub4.CrossRefPubMed

43.

Afghani E, Lo SK, Covington PS, Cash BD, Pandol SJ. Sphincter of Oddi Function and Risk Factors for Dysfunction. Front Nutr. 2017;4:1. https://doi.org/10.3389/fnut.2017.00001.CrossRefPubMedPubMedCentral

44.

Toouli J. Sphincter of Oddi: Function, dysfunction, and its management. J Gastroenterol Hepatol. 2009;24 Suppl 3:S57-62. https://doi.org/10.1111/j.1440-1746.2009.06072.x.CrossRefPubMed

45.

Sharma SS. Sphincter of Oddi dysfunction in patients addicted to opium: an unrecognized entity. Gastrointest Endosc. 2002;55(3):427-30. https://doi.org/10.1067/mge.2002.121600.CrossRefPubMed

46.

Mousavi S, Toussy J, Zahmatkesh M. Opium addiction as a new risk factor of sphincter of Oddi dysfunction. Med Sci Monit. 2007;13(11):CR528-31.PubMed

47.

Thompson DR. Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol. 2001;96(4):1266-72. https://doi.org/10.1111/j.1572-0241.2001.03536.x.CrossRefPubMed

48.

Goff JS. The human sphincter of Oddi. Physiology and pathophysiology. Archives of internal medicine. 1988;148(12):2673-2677. PMID: 3058076.CrossRefPubMed

49.

Radnay PA, Duncalf D, Novakovic M, Lesser ML. Common bile duct pressure changes after fentanyl, morphine, meperidine, butorphanol, and naloxone. Anesthesia and analgesia. 1984;63(4):441-4. https://doi.org/10.1213/00000539-198404000-00012.CrossRefPubMed

50.

Sherman S, Lehman GA. Opioids and the sphincter of Oddi. Gastrointest Endosc. 1994;40(1):105-6. https://doi.org/10.1016/s0016-5107(94)70027-3.CrossRefPubMed

51.

Akbarali HI, Inkisar A, Dewey WL. Site and mechanism of morphine tolerance in the gastrointestinal tract. Neurogastroenterol Motil. 2014;26(10):1361-7. https://doi.org/10.1111/nmo.12443.CrossRefPubMedPubMedCentral

52.

Leedham JA, Jian-Qiang K, Taylor DA, Johnson SM, Fleming WW. Membrane potential in myenteric neurons associated with tolerance and dependence to morphine. The Journal of pharmacology and experimental therapeutics. 1992;263(1):15-9.PubMed

53.

Rezvani A, Huidobro-Toro JP, Hu J, Way EL. A rapid and simple method for the quantitative determination of tolerance development to opiates in the guinea-pig ileum in vitro. J Pharmacol Exp Ther. 1983;225(2):251-55.PubMed

54.

Hackert T, Klaiber U, Hinz U, Kehayova T, Probst P, Knebel P et al. Sphincter of Oddi botulinum toxin injection to prevent pancreatic fistula after distal pancreatectomy. Surgery. 2017;161(5):1444-50. https://doi.org/10.1016/j.surg.2016.09.005.CrossRefPubMed

55.

Rieder B, Krampulz D, Adolf J, Pfeiffer A. Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy. Gastrointest Endosc. 2010;72(3):536-42. https://doi.org/10.1016/j.gie.2010.04.011.CrossRefPubMed

56.

Abe N, Sugiyama M, Suzuki Y, Yamaguchi Y, Yanagida O, Masaki T et al. Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. Am J Surg. 2006;191(2):198-200. https://doi.org/10.1016/j.amjsurg.2005.07.036.CrossRefPubMed

57.

Frozanpor F, Lundell L, Segersvard R, Arnelo U. The effect of prophylactic transpapillary pancreatic stent insertion on clinically significant leak rate following distal pancreatectomy: results of a prospective controlled clinical trial. Ann Surg. 2012;255(6):1032-6. https://doi.org/10.1097/SLA.0b013e318251610f.CrossRefPubMed

58.

Marchegiani G, Barreto SG, Bannone E, Sarr M, Vollmer CM, Connor S et al. Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading From the International Study Group for Pancreatic Surgery (ISGPS). Ann Surg. 2022;275(4):663-72. https://doi.org/10.1097/SLA.0000000000005226.CrossRefPubMed

59.

Wilson RB. Morpheus and the Underworld-Interventions to Reduce the Risks of Opioid Use After Surgery: ORADEs, Dependence, Cancer Progression, and Anastomotic Leakage. J Gastrointest Surg. 2019;23(6):1240-9. https://doi.org/10.1007/s11605-019-04167-3.CrossRefPubMed

Titel: Postoperative Opioid Use Is Associated with Increased Rates of Grade B/C Pancreatic Fistula After Distal Pancreatectomy
verfasst von: Artem Boyev
Laura R. Prakash
Yi-Ju Chiang
Christopher P. Childers
Anish J. Jain
Timothy E. Newhook
Morgan L. Bruno
Elsa M. Arvide
Whitney L. Dewhurst
Michael P. Kim
Naruhiko Ikoma
Jeffrey E. Lee
Rebecca A. Snyder
Matthew H. G. Katz
Ching-Wei D. Tzeng
Jessica E. Maxwell
Publikationsdatum: 19.07.2023
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 10/2023
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-023-05751-4

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