Improvements to Patient Recovery Strategies Lower Long-term Opioid Usage After Colorectal Surgery

Minimizing opioid exposure during and after colorectal surgery can decrease long-term opioid use in some patients, according to new research by Mass General Brigham investigators. The retrospective, multicenter study determined that progressively fewer patients remained on opioids one year after surgery as hospitals improved protocols to avoid narcotic medications. Results are published in the Journal of Surgical Research.

“Surgeons must balance between providing adequate pain control while avoiding addiction postoperatively,” said corresponding author Ronald Bleday, MD, section chief of the division of colorectal surgery at Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system. “Our study demonstrates that institutional collaboration and constant improvements in the care we offer after surgery can reduce long-term narcotics usage in postoperative colon and rectal surgery patients.”

High rates of inpatient opioid consumption can lead to persistent narcotic use even in people without a history of drug abuse. Seeking to limit opioid use, the Mass General Brigham Colorectal Surgery Collaborative implemented modified enhanced recovery after surgery (ERAS) pathways—in-hospital strategies to optimize patient recovery. These opioid-sparing strategies included minimizing the use of long-acting narcotics during anesthesia, administering intravenous non-narcotic medications such as acetaminophen to postoperative patients and standardizing the dose and number of opioids prescribed at the time of discharge.

The research team examined trends in postoperative opioid use as the ERAS protocols were being developed across five participating Mass General Brigham sites between 2017 and 2020. The cohort included 1,363 patients who underwent elective colon or rectal surgery during the study period and had not been prescribed opioids a year prior to the procedure. Nearly all (99.6%) of the patients were prescribed opioids after surgery.

The researchers found a stepwise reduction in long-term opioid usage (more than 6 months postoperatively) with increases in ERAS interventions during the study period. The proportion of patients who continued to use opioids six months postoperatively dropped from 16% between 2017-2018 to 11% between 2019–2020. Similarly, 11% of patients remained on opioids 12 months postoperatively in 2017–2018 compared to 4% in 2019–2020. Additional analysis of a separate cohort in 2023–2024 revealed that only one out of 445 patients was still on opioids 3 months postoperatively.

Authorship: In addition to Bleday, Mass General Brigham authors include Kerri A. McKie, Robert A. Malizia, Adam C. Fields, Liliana Bordeianou, and Khawaja Fraz Ahmed. Additional authors include Marc Rubin and Todd Francone.

Disclosures: None.

Funding: None.

Paper cited: McKie KA et al. “Long-Term Opioid Use After Colon and Rectal Surgery” Journal of Surgical Research DOI: 10.1016/j.jss.2025.04.019