Enhanced recovery after surgery protocol is associated with a lower postoperative opioid use and a reduced postoperative office burden (470)

Abstract

<b>Objectives:</b> Patients receiving postoperative opioids have a dosedependent risk of misuse and addiction. While the introduction of the enhanced recovery after surgery (ERAS) protocol has been shown to decrease hospital narcotic use, less attention has been directed towards the impact of ERAS on the clinic burden with respect to postoperative care. The objective of our study was to determine the impact of an ERAS protocol on narcotic prescription patterns after laparoscopic gynecologic surgery measured as the number of prescription pain medication refill requests, clinic phone calls, and unscheduled visits in the 30-day postoperative period. <b>Methods:</b> This retrospective study compared postoperative narcotic prescriptions and clinic burden ten months prior to and ten months following the implementation of a standard ERAS protocol after laparoscopic gynecologic surgery. The study included patients who underwent surgeries between January 2018, and July 2019, with the ERAS implementation in November 2018. The total oral morphine milligram equivalents (MMEs) prescribed postoperatively, and the number of unscheduled clinic visits and phone calls were compared before and after the implementation of the ERAS protocol. Postoperative prescribing practices were not standardized during the study period. <b>Results:</b> A total of 791 patients were identified with clinic follow-up; 445 before and 346 after ERAS implementation. All patients underwent laparoscopic or robotic-assisted surgery alone or in combination with mini-laparotomy. Baseline characteristics, including procedure, diagnosis, smoking, and alcohol use did not differ between groups. Use of ERAS was associated with higher rates of same-day discharge (49% vs 39%, p=0.003) and lower readmission rates (2.0% vs 5.6%, p=0.011). Postoperatively, patients who received the ERAS protocol were prescribed significantly less narcotics (197.8 vs 223.5 MMEs, p=0.0087) even though the postop narcotic doses were not specified. The number of refill requests was lower with ERAS (1.7% vs 3.6%, p=0.11). ERAS was associated with a lower chance of postoperative clinic phone calls (38% vs 46%, p=0.023), including calls for pain (10% vs 16%, p=0.021). There was a decrease in unscheduled visits related to pain (1.5% vs 5.8%, p=0.001), and a trend towards a decrease in the number of overall unscheduled visits (14% vs 18%; p=0.08) after ERAS implementation. <b>Conclusions:</b> Implementation of the ERAS protocol after laparoscopic gynecologic surgery resulted in a decrease in postoperative opioid prescribing and a lower incidence of unplanned interactions with the clinic staff, despite the lower amount of prescribed postoperative narcotics.