scholarly journals 647: Reduction of post-operative opioid use after implementation of Enhanced Recovery After Cesarean Surgery (ERACS) program

2020 ◽  
Vol 222 (1) ◽  
pp. S412-S413
Author(s):  
C. Andrew Combs ◽  
Tracy Robinson ◽  
Cindy Mekis ◽  
Marsjah Cooper ◽  
Sarah Lee
Keyword(s):  
Enhanced Recovery ◽  
Opioid Use

scholarly journals The Association between Implementation an Enhanced Recovery after Cesarean Pathway with Standardized Discharge Prescriptions and Opioid Use and Pain Experience after Cesarean Delivery

2021 ◽  
Author(s):  
Jennifer A. McCoy ◽  
Sarah Gutman ◽  
Rebecca F. Hamm ◽  
Sindhu K. Srinivas
Keyword(s):  
Cesarean Delivery ◽  
Pain Control ◽  
Enhanced Recovery ◽  
Median Number ◽  
Baseline Survey ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
Hospital Patients

Objective This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. Study Design We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge. Results Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90–195] PRE to 114 [range: 45–168] POST (p = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5–8] vs. POST 5 [range: 3–7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16–30] vs. POST 17.5 [range: 4–25], p = 0.001). The number of pills consumed was significantly associated with number prescribed (p < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2–6] vs. POST 3[range: 1–5], p = 0.03). Conclusion Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients. Key Points

scholarly journals Enhanced recovery after cesarean: impact on postoperative opioid use and length of stay

2020 ◽  
Author(s):  
C. Andrew Combs ◽  
Tracy Robinson ◽  
Cindy Mekis ◽  
Marsjah Cooper ◽  
Elizabeth Adie ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Opioid Use

Enhanced Recovery After Surgery Pathway for Cesarean Delivery: Effect on Opioid Use and Pain Scores [5K]

2019 ◽  
Vol 133 (1) ◽  
pp. 119S-119S ◽  
Author(s):  
Emily E. Fay ◽  
Carlos C. Delgado ◽  
Jane Hitti ◽  
Leah Savitsky ◽  
Elizabeth Mills ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Opioid Use ◽  
Pain Scores

Preoperative opioid use is associated with increased risk of postoperative complications within a colorectal-enhanced recovery protocol

2020 ◽  
Author(s):  
Taryn E. Hassinger ◽  
Elizabeth D. Krebs ◽  
Florence E. Turrentine ◽  
Robert H. Thiele ◽  
Bethany M. Sarosiek ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Enhanced Recovery ◽  
Opioid Use ◽  
Increased Risk ◽  
Enhanced Recovery Protocol

Enhanced Recovery After Surgery Protocol for Opioid Use Reduction in Ambulatory Thyroid and Parathyroid Surgery

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Merry Peckham ◽  
Erin Creighton ◽  
Mikayla Troughton ◽  
Jessica Yeh ◽  
Riley Lide ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Parathyroid Surgery ◽  
Opioid Use

scholarly journals Characterizing the Risk and Outcome Profiles of Lumbar Fusion Procedures in Patients With Opioid Use Disorders: A Step Towards Improving Enhanced Recovery Protocols for a Unique Patient Population

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael L Martini ◽  
Dominic A Nistal ◽  
Brian C Deutsch ◽  
Jeffrey Gilligan ◽  
Robert J Rothrock ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Enhanced Recovery ◽  
Lumbar Fusion ◽  
National Level ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Opioid Use ◽  
Opioid Use Disorders ◽  
Procedure Type ◽  
Total Charges

Abstract INTRODUCTION This national-level study sought to provide a necessary assessment of the risks and outcomes for different lumbar fusion procedures in patients with opioid use disorders (OUDs) to help guide the future development of targeted enhanced recovery after surgery (ERAS) protocols for this unique population. METHODS Data for patients with or without OUDs who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lateral transverse lumbar interbody fusion (LLIF) for lumbar disc degeneration (LDD) were collected from the 2013 to 2014 National Inpatient Sample. Multivariable logistic regression was implemented to analyze how OUD impacted in-hospital complications, length of hospitalization, discharge disposition, and total charges by procedure type. RESULTS A total of 139 995 patients with LDD were identified, with 1280 patients (0.91%) also having a concurrent OUD diagnosis. Overall complication rates were higher in OUD patients (48.44% vs 31.01%; P < .0001). OUD patients had higher odds of pulmonary (P = .0006), infectious (P < .0001), and hematological complications (P = .0009). Multivariate regression modeling of outcomes by procedure type showed that following ALIF, OUD increased odds of nonhome discharge (P = .0007), extended hospitalization (P = .0002), and greater total charges (P = .0054). This analysis also revealed that OUD increased odds of complication (P = .0149 and P = .0471), extended hospitalization (P = .0439 and P = .0001), and higher total charges (P < .0001) following PLIF and LLIF procedures, respectively. CONCLUSION Obtaining a better understanding of the risks and outcomes that OUD patients face perioperatively is a necessary step towards developing more effective ERAS protocols for this vulnerable population. This study, which sought to characterize outcome profiles for lumbar fusion procedures in OUD patients on a national level, found this population experienced increased odds of complication, extended hospitalization, nonhome discharge, and higher total charges. Results from this study warrant future prospective studies to better understand these associations and further the development of ERAS programs to improve patient care and reduce cost burden.

Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

2019 ◽  
Vol 35 (09) ◽  
pp. 695-704 ◽  
Author(s):  
Carol E. Soteropulos ◽  
Sherry Y.Q. Tang ◽  
Samuel O. Poore
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Breast Reconstruction ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Management ◽  
Patient Counseling ◽  
Opioid Use ◽  
Full Spectrum ◽  
Alloplastic Breast Reconstruction

Background Enhanced Recovery after Surgery (ERAS) principles have received focused attention in breast reconstruction. Many protocols have been described in the literature for both autologous and alloplastic reconstruction. This systematic review serves to better characterize successful ERAS protocols described in the literature for potential ease of adoption at institutions desiring implementation. Methods A systematic review of ERAS protocols for autologous and alloplastic breast reconstruction was conducted using Medline, the Cochrane Database, and Web of Science. Results Eleven cohort studies evaluating ERAS protocols for autologous (n = 8) and alloplastic (n = 3) breast reconstruction were included for review. The majority compared with a retrospective cohort of traditional perioperative care. All studies described the full spectrum of implemented ERAS protocols including preoperative, intraoperative, and postoperative phases of care. Most frequently reported significant outcomes were reduced length of stay and opioid use with ERAS implementation. No significant change in major complication or readmission rate was demonstrated. Conclusion Based on this systematic review, several core elements that make up a successful perioperative enhanced recovery protocol for breast reconstruction have been identified. Elements include patient counseling and education, limited preoperative fasting, appropriate thromboprophylaxis and antibiotic prophylaxis dependent on reconstructive method, preoperative antiemetics, multimodal analgesia and use of local anesthetic, goal-directed intravenous fluid management, prompt removal of drains and catheters, early diet advancement, and encouragement of ambulation postoperatively. Implementation of ERAS protocols in both autologous and alloplastic breast reconstruction can positively enhance patient experience and improve outcomes by reducing length of stay and opioid use, without compromising successful reconstructive outcomes.

scholarly journals Enhanced Recovery After Surgery to Change Process Measures and Reduce Opioid Use After Cesarean Delivery

2019 ◽  
Vol 134 (3) ◽  
pp. 511-519 ◽  
Author(s):  
Monique Hedderson ◽  
Derrick Lee ◽  
Eric Hunt ◽  
Kimberly Lee ◽  
Fei Xu ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Change Process ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Opioid Use ◽  
Process Measures

Comparison of patient reported symptom burden in patients with ovarian cancer undergoing primary vs. interval tumor reductive surgery.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5557-5557 ◽  
Author(s):  
Larissa Meyer ◽  
Qiuling Shi ◽  
Maria Iniesta ◽  
Melinda Harris ◽  
Charlotte C. Sun ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Enhanced Recovery ◽  
Symptom Burden ◽  
Urinary Urgency ◽  
Opioid Use ◽  
Emotional Symptoms ◽  
Mixed Effect ◽  
Work Activity ◽  
Patient Reported

5557 Background: Patient-reported outcomes (PROs) are important in comparative effectiveness research. We compared symptom burden and functional recovery in pts undergoing primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy (NACT) and interval cytoreductive surgery (ICS) within an enhanced recovery after surgery program (ERAS). Methods: Perioperative PROs were measured for women with ovarian cancer undergoing PCS or ICS using the MD Anderson Symptom Inventory- Ovarian Cancer, a 27-item validated tool which was administered preoperatively, daily in hospital, and at least weekly for 8 weeks post-op. Mixed-effect modeling was performed. Results: 108 pts (45 PCS, 63 ICS) participated. There was no difference in median age, Charlson comorbidity index, ASA status, history of chronic opioid use, length of stay or readmission rate. At pre-op baseline assessment, the mean pain score was higher in the PCS group (3.8 vs. 1.8, p = .0005). ICS pts had a lower median surgical complexity score (4.0 vs. 2.0, p = .03), and shorter median surgical time (260 min vs. 223 min, p = .05). During hospitalization, pts undergoing PCS reported significantly more bloating, urinary urgency, distress, sadness and mood disturbance. Women who received NACT had a significantly higher symptom burden of neuropathy, leg cramps and memory disturbances. There was no difference in pain, fatigue, drowsiness, nausea, or emesis within the first 5 days postoperatively. While there was no significant differences in the physical interference composite score, (walking, work, activity), those who underwent ICS had improved affective interference scores (mood, relations, enjoyment of life). Conclusions: Within an ERAS program, there were few significant differences in surgery related symptoms related to physical recovery between pts undergoing PCS or ICS. The differences in overall symptom burden suggest that disease related symptoms (pain, bloating, urinary urgency) and emotional symptoms may be related to recent diagnosis and higher tumor burden in pts undergoing PCS while the increased numbness, leg cramps and memory issues reflect chemo-related effects in the ICS cohort.

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