MP80-06 THE EFFECT OF CHRONIC NARCOTIC USE ON RECOVERY FOLLOWING RADICAL CYSTECTOMY WITH ENHANCED RECOVERY PROTOCOL

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2018MP80-06 THE EFFECT OF CHRONIC NARCOTIC USE ON RECOVERY FOLLOWING RADICAL CYSTECTOMY WITH ENHANCED RECOVERY PROTOCOL Brian Cameron, Saum Ghodoussipour, Soroush Bazargani, Jie Cai, Gus Miranda, Siamak Daneshmand, and Hooman Djaladat Brian CameronBrian Cameron More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Soroush BazarganiSoroush Bazargani More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2694AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous research has shown that enhanced recovery after surgery (ERAS) protocols improve outcomes and shorten hospital stay following radical cystectomy and urinary diversion. These protocols focus on minimizing the use of narcotic pain medications post-operatively and the use of μ-opioid antagonists. The effect of preoperative narcotic exposure on patient outcomes within ERAS protocols is unknown. Herein, we evaluate whether patients with a history of preoperative narcotic use differ in outcomes compared to preoperative narcotic naive patients who undergo radical cystectomy and urinary diversion within our ERAS protocol METHODS Using our prospectively maintained IRB approved bladder cancer database, we reviewed 294 patients who underwent open radical cystectomy and urinary diversion for urothelial carcinoma with ERAS protocol between 5/2012 and 12/2015. We identified 44 patients with preoperative (mean >30 days) narcotic use and matched them (based on age, sex, BMI, CCI, pathologic stage, and diversion type) to 88 patients without preoperative narcotic use. Post-operative opioid use and visual analog scale (VAS) pain scores were analyzed and compared up to post-operative day 3. All routes of opioid use were recorded and converted to a morphine equivalent dose (MED). Post-operative records were also reviewed for length of stay (LOS), 30-day GI complications and readmissions. RESULTS Patients with previous narcotic use reported higher VAS pain scores (4 vs. 3.1, p=0.007) and used significantly more opioids (13.3 MED vs. 8.6, p=0.003) following surgery. There was no observed difference in median LOS (4 vs. 4 days, p=0.8), 30-day GI complications (20.4% vs. 20.4%, p=1.0) or 30-day readmission rates (20.4% vs. 9%, p=0.09). CONCLUSIONS Patients with preoperative narcotic exposure might experience more pain and require more opioid use after radical cystectomy within an enhanced recovery protocol. There was, however, no observed difference in hospital stay, early GI complications or readmission rates. Special consideration should be taken in managing pain in ERAS patients with prior narcotics use. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1091 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Brian Cameron More articles by this author Saum Ghodoussipour More articles by this author Soroush Bazargani More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Siamak Daneshmand More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...