VARYING MULTIMODAL ANALGESIA COMPLIANCE WITH ERAS & IMPACT ON OPIOID CONSUMPTION POST-COLECTOMY
Jackly M. Juprasert*, Heather Yeo
Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY
BACKGROUND: In the US, an estimated 130 people die every day from opioid overdose accounting for almost 50,000 deaths per year. Opioid minimization in the postoperative period presents an opportunity to prevent long-term opioid use. Recently, there has been a paradigm shift towards utilizing enhanced recovery after surgery (ERAS) protocols, and because it employs multimodal analgesia, it is hypothesized that ERAS can decrease the need for opioids. The aim of this study is to determine if the ERAS protocol decreases perioperative opioid consumption for patients undergoing laparoscopic colectomy.
METHODS: We conducted a retrospective analysis of prospectively collected data for patients undergoing laparoscopic colectomy from 2014-2018. The ERAS protocol was implemented in 2016 at one academic institution while the other two community hospitals did not have a mandated ERAS protocol during this time. Patients were pooled together and divided into three cohorts based on level of multimodal analgesia protocol compliance: 1) patients who did not receive any non-opioid analgesics, 2) patients who received 1 or 2 different types of non-opioid analgesics or 3) patients who received three or more different types of non-opioid analgesics. All opioids administered within 72 hours post-operatively were tabulated and converted to oral milligram morphine equivalent (MME) for comparison. One-way ANOVA was used to assess differences in mean variables and Chi-square or Fisher’s exact test was utilized for the remaining categorical variables where appropriate.
RESULTS: 505 patients were identified who underwent laparoscopic colectomy from 2014 to 2018. There was no significant difference in sex (p=0.5), race (p=0.2), or the number of opioid naive patients (p=0.5) within the three cohorts. Cohort 3 had the shortest length of stay (p<0.001) and time to return of bowel function (p<0.001). During the 72 hour period after surgery, cohort 3 consumed the lowest oral MME of opioids (p<0.001). Subgroup analysis of non-opioid naive patients showed the same significant difference between cohorts in 72 hour MME (p=0.002). Opioid naive patients had a higher frequency of opioid free hospitalizations than non-opioid naive patients.
CONCLUSION: ERAS appears to be associated with decreased length of stay, time to return of bowel function, and the use of post-operative opioids in patients undergoing laparoscopic colectomy as expected. Patients experienced a decrease in the amount of opioids used postoperatively regardless if they were opioid naive or not. In the context of the opioid epidemic, ERAS protocols utilizing multimodal analgesia should be expanded to other surgeries and subspecialties to decrease post-surgical patients exposure to opioids in hopes that this will prevent patients from becoming long-term opioid users and subsequently decrease the risk of opioid overdose.
Table 1: Perioperative data
Figure 1: MME by POD
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