Abstract
Postoperative pain management is one of the important components for enhanced recovery. High-dose oral acetaminophen is effective; however, the safety of long-course usage has not been established in gastrointestinal surgeries. This study aimed to investigate the clinical outcomes of patients with colorectal cancer using high-dose acetaminophen. One hundred sixty-five consecutive colorectal cancer patients using high-dose oral acetaminophen (3600 mg/day between POD1 and POD7) were enrolled. One hundred forty-six patients (88.5%) completed the administration of high-dose oral acetaminophen. Drug-induced liver injury occurred in 55 patients (33.3%), and the cumulative incidence rates were 18.9% and 36.8% on POD6 and POD7, respectively. The severity of liver injury was grade 1 in all cases, which returned to normal without treatment. Patients with drug-induced liver injury had a higher frequency of dyslipidemia (47.3% versus 23.6%, P = 0.0021) and M1 staging (10.9% versus 1.0%, P = 0.0027). Multivariate analysis showed that the presence of dyslipidemia (OR 2.91, P = 0.0030) and M1 staging (OR 13.5, P = 0.019) were independent risk factors for drug-induced liver injury. Long-course usage of high-dose oral acetaminophen in colorectal cancer patients enrolled in enhanced recovery protocols is feasible. Moreover, the presence of dyslipidemia and the M status are risk factors for drug-induced liver injury.