Investigating Prolonged Perioperative Opioid Use in Surgical Oncology

Ronald Bleday, MD, co-director of the Colon and Rectal Cancer Center at Dana-Farber Cancer Institute and vice chair for Quality and Patient Safety in the Department of Surgery and section chief of the Division of Colorectal Surgery at Brigham and Women’s Hospital, and associate professor at Harvard Medical School, observed that many of his patients were taking opioids well past the perioperative period for colorectal surgery.

In a conversation with CancerNetwork®, Bleday discussed the rationale for conducting a retrospective cohort study published in the Journal of Surgical Research exploring enhanced recovery after surgery (ERAS) pathways in limiting perioperative opioid use. He further touched upon how independent predictors for new persistent opioid use (NPOU) could be implemented into a pre-surgical assessment for pain management expectations and potential opioid risk.

Bleday began by highlighting an observation made prior to and leading up to the study, which highlighted opioid use well beyond the perioperative period in patients undergoing colorectal surgery. This prompted an investigation into assessing prolonged opioid use following a procedure stratified by historical opioid or pain medicine use and chronic pain.

He further suggested that, with the help of a chronic pain clinic, his team can individually assess risk based on a patient’s previous opioid use. He concluded by saying that the chronic pain team is particularly beneficial for managing opioid use in opioid-dependent populations.

Transcript:

One of the things we saw in our patients many years ago, and leading up to the beginning of the study, was that they would still be on opioids well past the perioperative period, when there theoretically was no incisional pain. That got us looking at our results of [the number of] patients on opioids, 1 month, 3 months, and 6 months after patients had, say, a routine colectomy. We divided the retrospective assessment into 2 groups: those who were opioid naive in the year prior, and those who had been on some pain medicine, and patients with chronic pain. We primarily looked at those patients who were opioid naive as they came into their surgery.

We divided the patients into those who have been on opioids within the past year, maybe a previous operation, or some orthopedic problem that forces them to be on chronic opioids or chronic benzodiazepines. Then you need to look at those patients much more individually to see what their risk is. We also have the help of a chronic pain clinic for those patients who are on [many] opioids as they come into their elective or urgent colorectal surgery. It is making that determination of opioid naive vs non-opioid naive before the perioperative period, and then for the patients who are opioid dependent, in particular, getting your chronic pain team to consult and help you during the perioperative period.

Reference

McKie KA, Malizia RA, Fields AC, et al. Long term opioid use after colon and rectal surgery. J Surg Res. 2025;311:86-91. doi:10.1016/j.jss.2025.04.019