286. Early adoption of enhanced recovery after surgery protocol following adult spinal deformity surgery is not associated with decreased in-hospital opioid use

Abstract

BACKGROUND CONTEXT The United States is facing an opioid crisis. Opioid use is common and widespread in the adult spinal deformity (ASD) population. Enhanced Recovery After Surgery (ERAS) is a multimodal and multidisciplinary evidence-based, perioperative approach for surgery intended to reduce surgical morbidity and improve recovery. We sought to evaluate the effects of ERAS implementation on postoperative opiate consumption, length of stay (LOS), and postoperative day of ambulation (PDA) following ASD surgery. PURPOSE The purpose of this study is to test if the implementation of ERAS protocol will help reduce in-hospital opioid use, length of stay and postoperative day of ambulation following ASD surgery. STUDY DESIGN/SETTING Single site, multisurgeon, retrospective longitudinal cohort study. PATIENT SAMPLE We sampled a total of 50 patients, 6 months pre- (n=20) and post- (n=30) ERAS implementation. METHODS A single center, multisurgeon, retrospective review identified patients with adult deformity who underwent ASD surgery 6 months pre- (n=20) and post- (n=30) ERAS implementation. The 2 cohorts were statistically similar in age, sex, BMI, diagnosis, ASA grade and levels fused. Total morphine equivalent doses (MED) in-hospital as well as 90-day postoperative prescriptions were calculated. LOS and PDA were also evaluated. Preoperative opiate prescriptions were recorded to determine baseline opioid use. RESULTS We found no difference in hospital postoperative mean total MED between the 2 cohorts (preERAS=263, postERAS=211, p=0.44). The 90-day mean total MED was also not significantly different between the cohorts (preERAS= 572, postERAS=326, p=0.12). 25 (50%) patients were taking opiates prior to surgery. Opiate naive patients required significantly less in-hospital mean total MED compared to nonopiate naive patients (124 vs 629, p=0.02, respectively). However, 90-day mean total MED was not significantly different between the 2 cohorts (naive=197 vs non-opiate naive=311, p=0.18). LOS for ERAS cohort (5.20.±73) was less when compared to preERAS cohort (5.9±0.6, p=0.22), but this was not significant. PDA was significantly decreased after ERAS implementation (1.1 vs 0.43, p=0.006). CONCLUSIONS Early adoption of ERAS did not decrease in-hospital opioid consumption or total 90-day opioid prescription. In-hospital opioid consumption was correlated with preoperative opioid use. Decreasing presurgical opioid use has a significant effect on postoperative patient opioid consumption and should be implemented as part of ERAS protocol. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.