A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one
Abstract Background Opioid use has come under increasing scrutiny, driven in part by the opioid crisis and growing concerns that up to 6% of opioid-naïve patients may become chronic opioid users. This has resulted in a revaluation of perioperative practice. For this reason, we implemented a multidis...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Perioperative Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13741-023-00331-1 |
| _version_ | 1827188871754940416 |
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| author | Michael W. Manning John Whittle Matthew Fuller Sara H. Cooper Erin L. Manning Joe Chapman Judd W. Moul Timothy E. Miller |
| author_facet | Michael W. Manning John Whittle Matthew Fuller Sara H. Cooper Erin L. Manning Joe Chapman Judd W. Moul Timothy E. Miller |
| author_sort | Michael W. Manning |
| collection | DOAJ |
| description | Abstract Background Opioid use has come under increasing scrutiny, driven in part by the opioid crisis and growing concerns that up to 6% of opioid-naïve patients may become chronic opioid users. This has resulted in a revaluation of perioperative practice. For this reason, we implemented a multidisciplinary pathway to reduce perioperative opioid usage through education and standardization of practice. Methods A single-centre retrospective evaluation was performed after 1 year, comparing the outcomes to those of the 2 years prior to pathway implementation. Comparisons were made between pre- vs. post pathway change by 2:1 propensity matching between cohorts. Univariate linear regression models were created using demographic variables with those that were p < 0.15 included in the final model and using post-operative opioid use (in oral morphine equivalents, OME) as the primary outcome. Results We found that intraoperative opioid use was significantly decreased 38.2 mg (28.3) vs. 18.0 mg (40.4) oral morphine equivalents (OME), p < .001, as was post-operative opioid use for the duration of the hospitalization, 46.3 mg (49.5) vs. 35.49 mg (43.7) OME, p = 0.002. In subgroup analysis of those that received some intraoperative opioids (n = 152) and those that received no opioids (n = 34), we found that both groups required fewer opioids in the post-operative period 47.0 mg (47.7) vs. 32.4 mg (40.6) OME, p = 0.001, + intraoperative opioids, 62.4 mg (62.9) vs. 35.8 mg (27.7) OME, p = 0.13, - intraoperative opioids. Time to discharge from the PACU was reduced in both groups 215 min (199) vs. 167 min (122), p < 0.003, + intraoperative opioids and 253 min (270) vs. 167 min (105), p = 0.028, - intraoperative opioids. The duration of time until meeting discharge criteria from PACU was 221 min (205) vs. 170 min (120), p = 0.001. Hospital length of stay (LOS) was significantly reduced 1.4 days (1.3) vs. 1.2 days (0.8), p = 0.005. Both sub-groups demonstrated reduced hospital LOS 1.5 days (1.4) vs. 1.2 days (0.8), p = 0.0047, + intraoperative opioids and 1.7 days (1.6) vs. 1.3 days (0.9), p = 0.0583, - intraoperative opioids. Average pain scores during PACU admission and post-PACU until discharge were not statistically different between cohorts. Conclusions These findings underscore the effectiveness of a multidisciplinary approach to reduce opioids. Furthermore, it demonstrates improved patient outcomes as measured by both shorter PACU and almost 50% reduction in perioperative opioid use whilst maintaining similar analgesia as indicated by patient-reported pain scores. |
| first_indexed | 2024-03-12T17:06:49Z |
| format | Article |
| id | doaj.art-20e108a4873240168f1094ec8f60c722 |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2025-03-21T07:44:58Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-20e108a4873240168f1094ec8f60c7222024-07-14T11:26:54ZengBMCPerioperative Medicine2047-05252023-08-0112111010.1186/s13741-023-00331-1A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year oneMichael W. Manning0John Whittle1Matthew Fuller2Sara H. Cooper3Erin L. Manning4Joe Chapman5Judd W. Moul6Timothy E. Miller7Department of Anaesthesiology, Duke UniversityCentre for Perioperative Medicine, Division of Surgery & Interventional Science, UCLDepartment of Biostatistics, Duke UniversityDepartment of Pharmacy, Duke UniversityDepartment of Anaesthesiology, Duke UniversityDepartment of Anaesthesiology, Duke UniversityDepartment of Surgery, Duke UniversityDepartment of Anaesthesiology, Duke UniversityAbstract Background Opioid use has come under increasing scrutiny, driven in part by the opioid crisis and growing concerns that up to 6% of opioid-naïve patients may become chronic opioid users. This has resulted in a revaluation of perioperative practice. For this reason, we implemented a multidisciplinary pathway to reduce perioperative opioid usage through education and standardization of practice. Methods A single-centre retrospective evaluation was performed after 1 year, comparing the outcomes to those of the 2 years prior to pathway implementation. Comparisons were made between pre- vs. post pathway change by 2:1 propensity matching between cohorts. Univariate linear regression models were created using demographic variables with those that were p < 0.15 included in the final model and using post-operative opioid use (in oral morphine equivalents, OME) as the primary outcome. Results We found that intraoperative opioid use was significantly decreased 38.2 mg (28.3) vs. 18.0 mg (40.4) oral morphine equivalents (OME), p < .001, as was post-operative opioid use for the duration of the hospitalization, 46.3 mg (49.5) vs. 35.49 mg (43.7) OME, p = 0.002. In subgroup analysis of those that received some intraoperative opioids (n = 152) and those that received no opioids (n = 34), we found that both groups required fewer opioids in the post-operative period 47.0 mg (47.7) vs. 32.4 mg (40.6) OME, p = 0.001, + intraoperative opioids, 62.4 mg (62.9) vs. 35.8 mg (27.7) OME, p = 0.13, - intraoperative opioids. Time to discharge from the PACU was reduced in both groups 215 min (199) vs. 167 min (122), p < 0.003, + intraoperative opioids and 253 min (270) vs. 167 min (105), p = 0.028, - intraoperative opioids. The duration of time until meeting discharge criteria from PACU was 221 min (205) vs. 170 min (120), p = 0.001. Hospital length of stay (LOS) was significantly reduced 1.4 days (1.3) vs. 1.2 days (0.8), p = 0.005. Both sub-groups demonstrated reduced hospital LOS 1.5 days (1.4) vs. 1.2 days (0.8), p = 0.0047, + intraoperative opioids and 1.7 days (1.6) vs. 1.3 days (0.9), p = 0.0583, - intraoperative opioids. Average pain scores during PACU admission and post-PACU until discharge were not statistically different between cohorts. Conclusions These findings underscore the effectiveness of a multidisciplinary approach to reduce opioids. Furthermore, it demonstrates improved patient outcomes as measured by both shorter PACU and almost 50% reduction in perioperative opioid use whilst maintaining similar analgesia as indicated by patient-reported pain scores.https://doi.org/10.1186/s13741-023-00331-1ERASOpioidOpioid-free anaesthesia |
| spellingShingle | Michael W. Manning John Whittle Matthew Fuller Sara H. Cooper Erin L. Manning Joe Chapman Judd W. Moul Timothy E. Miller A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one Perioperative Medicine ERAS Opioid Opioid-free anaesthesia |
| title | A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one |
| title_full | A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one |
| title_fullStr | A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one |
| title_full_unstemmed | A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one |
| title_short | A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one |
| title_sort | multidisciplinary opioid reduction pathway for robotic prostatectomy outcomes at year one |
| topic | ERAS Opioid Opioid-free anaesthesia |
| url | https://doi.org/10.1186/s13741-023-00331-1 |
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