Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2016; 8(7): 543-549
Published online Jul 15, 2016. doi: 10.4251/wjgo.v8.i7.543
Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol
Varut Lohsiriwat
Varut Lohsiriwat, Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Lohsiriwat V solely contributed to this article.
Institutional review board statement: The study was reviewed and approved by the Siriraj Institutional Review Board (SIRB COA No. Si014/2013).
Informed consent statement: As the study is a retrospective review, a waiver of informed consent was approved by the Siriraj Institutional Review Board.
Conflict-of-interest statement: Varut Lohsiriwat has received fees for serving as a speaker for Pfizer, MSD and Johnson and Johnson (Thailand) Limited.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at bolloon@hotmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Varut Lohsiriwat, MD, PhD, Associate Professor of Surgery, Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang-Lung Road, Bangkok Noi, Bangkok 10700, Thailand. bolloon@hotmail.com
Telephone: +66-2-4198005Fax: +66-2-4121370
Received: February 21, 2016
Peer-review started: March 2, 2016
First decision: April 6, 2016
Revised: April 9, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: July 15, 2016
Processing time: 129 Days and 7.5 Hours
Abstract

AIM: To evaluate the opioid-sparing effect of selective cyclooxygenase-2 (COX-2) inhibitors on short-term surgical outcomes after open colorectal surgery.

METHODS: Patients undergoing open colorectal resection within an enhanced recovery after surgery protocol from 2011 to 2015 were reviewed. Patients with combined general anesthesia and epidural anesthesia, and those with acute colonic obstruction or perforation were excluded. Patients receiving selective COX-2 inhibitor were compared with well-matched individuals without such a drug. Outcome measures included numeric pain score and morphine milligram equivalent (MME) consumption on postoperative day (POD) 1-3, gastrointestinal recovery (time to tolerate solid diet and time to defecate), complications and length of postoperative stay.

RESULTS: There were 75 patients in each group. Pain score on POD 1-3 was not significantly different between two groups. However, MME consumption and MME consumption per kilogram body weight on POD 1-3 was significantly less in patients receiving a selective COX-2 inhibitor (P < 0.001). Median MME consumption per kilogram body weight on POD 1-3 was 0.09, 0.06 and nil, respectively in patients receiving a selective COX-2 inhibitor and 0.22, 0.25 and 0.07, respectively in the comparative group (P < 0.001), representing at least 59% opioid reduction. Patients prescribing a selective COX-2 inhibitor had a shorter median time to resumption of solid diet [1 (IQR 1-2) d vs 2 (IQR 2-3) d; P < 0.001] and time to first defecation [2 (IQR 2-3) d vs 3 (IQR 3-4) d; P < 0.001]. There was no significant difference in overall postoperative complications between two groups. However, median postoperative stay was significantly 1-d shorter in patients prescribing a selective COX-2 inhibitor [4 (IQR 3-5) d vs 5 (IQR 4-6) d; P < 0.001].

CONCLUSION: Perioperative administration of oral selective COX-2 inhibitors significantly decreased intravenous opioid consumption, shortened time to gastrointestinal recovery and reduced hospital stay after open colorectal surgery.

Keywords: Selective cyclooxygenase-2 inhibitor; Outcome; Colon surgery; Rectal surgery; Enhanced recovery after surgery; Opioid; Ileus; Non-steroidal anti-inflammatory drug; Pain

Core tip: This comparative study validates the effectiveness of perioperative administration of oral selective cyclooxygenase-2 (COX-2) inhibitors as a part of multimodal analgesia in an enhanced recovery after surgery protocol to significantly reduce opioid requirement (but not pain score) after open colorectal surgery. Our findings also indicate that opioid-sparing effect of selective COX-2 inhibitor has some important clinical benefits including quicker gastrointestinal recovery and shorter hospitalization.