Analysis of opioid use following implementation of a colorectal enhanced recovery after surgery program.
Objectives: Enhanced Recovery After Surgery (ERAS) programs were developed to limit perioperative care variability in an attempt to improve surgical outcomes. Multiple studies have established that ERAS programs shorten length of hospital stay, reduce infections/complications, and improve patient satisfaction. A standard component of ERAS programs is patient education about, and standardization of, pain care. Patient expectations are appropriately set, multimodal analgesia (MMA) is maximized, and opioids are (hopefully as a result) reduced. In 2015, we developed a multidisciplinary colorectal ERAS program, with almost immediate outcome improvements. Although we standardized MMA analgesic use and educated our patients about pain, we chose not to standardize or limit opioid use by anesthesia or surgery providers. We designed this retrospective chart review to compare opioid use of colorectal surgical patients before and after implementation of our ERAS program.
Methods: Following local IRB approval,181 consecutive patients from our colorectal ERAS registry were chosen for data analysis and a cohort of 66 pre-ERAS patients were chosen for comparison. A retrospective chart review was conducted to determine both opiate and non-opiate administration during the perioperative period starting on postoperative day zero (POD 0) through postoperative day three (POD 3). In order to standardize the opiate usage during the perioperative period, we converted all opiate usage to a morphine equivalent daily dosage (MEDD).
Results: Opiate use decreased in both groups on consecutive postsurgical days, with the ERAS group having a greater decline in opiate use during all time intervals (Table 1), however this difference achieved statistical significance only during the intraoperative period, POD0, and POD3 (p
Conclusions: Our data reveals a statistically significant decrease in the use of opiates in the ERAS group when compared to the Pre-ERAS group in the intraoperative, POD 0, and POD 3 time periods. Although use decreased at the other time points, the difference did not achieve statistical significance. As expected, we also found a dramatic increase in MMA use following program implementation. Additionally, we found that along with a decrease in opiates there was also a decrease in patients self-reported pain scores. These findings support our theory that a successfully implemented colorectal ERAS program can not only reduce length of stay and complications, but can also reduce opioid use while also providing better pain scores during the intra and postoperative periods through patient education and good MMA stewardship.
Larson B, McDavid M, Burandt D, Issa H, Tadros R, Soto R. Analysis of opioid use following implementation of a colorectal enhanced recovery after surgery program. Abstract presented at: Anesthesiology 2019. American Society of Anesthesiology, Orlando, FL; 2019 October 19-23.