Decreased Narcotic Use After the Implementation of ERAS Guidelines in Gynecologic Oncology at an Academic Center [24H

Abstract

INTRODUCTION: The Enhanced Recovery after Surgery (ERAS) program was made to provide a standard approach to pre- and post-operative care in order to decrease narcotics requirements for surgical pain. Also, improve peri-operative outcomes such as surgical complications, and readmission rates. Objective: To assess the impact on narcotic use before and after ERAS in gynecologic oncology patients. METHODS: IRB approved study. Retrospective cohort study in patients with newly diagnose endometrial cancer who underwent robotic assisted laparoscopic surgery from May 2016 to February 2019 at an Academic Center. Patient’s narcotic used, demographics, surgical outcomes, intra- and post-operative complications, blood loss, pain medication administered, length of stay, and hospital readmission was analyzed. RESULTS: One hundred thirty nine patients met study criteria. Forty-three and ninety-six patients were before and after the implementation of ERAS. Both groups were similar regarding demographics, age, body mass index, comorbidities, cancer histology, grade and stage. Narcotic use was significantly decreased in patients after ERAS introduction (26.73 vs 45.53 morphine equivalents, 95% CI 30.79 to 56.3; P=.008). The post-ERAS cohort also had increased use of multimodal drug therapy for pain (85% vs 63%, n=0.004) and increase gabapentin (12% vs 62%, P=.000) and NSAID use. (36% vs 16%, P=.017). ERAS introduction did not result in decreased length of stay, hospital readmissions, or surgical complications. CONCLUSION: ERAS incorporation decreased narcotics used and increased multimodal drug use for postoperative pain without compromising peri-operative outcomes.