Abstract
Enhanced recovery after thoracic surgery (ERATS) protocols use a combination of analgesics for pain control and have been associated with decreased opioid requirements. We investigated the impact of continual ERATS refinement on the incidence of opioid free discharge.
We retrospectively analyzed our prospectively maintained institutional database for elective, opioid-naïve robotic thoracoscopic procedures. Demographics, operative outcomes, postoperative opioid dispensed (morphine milligram equivalent – MME), opioid discharge status were collected. Our primary outcome of interest was factors associated with opioid free discharge; our secondary objective was to determine the incidence of new persistent opioid users.
466 patients from our optimized ERATS protocol were included,309 (66%) were discharged without opioids. However, 157(11%) of patients discharged without opioids required a prescription post discharge. Conversely, 7/157 patients (11%), never filled their opioid prescriptions given at discharges. Factors associated with opioid-free discharges were non-anatomic resections, mediastinal procedures, minimal pain and lack of opioid usage on the day of discharge. More importantly, 3.2% of opioid-free discharge patients became new persistent opioid users versus 10.8% of patients filling opioid prescriptions after discharges (p=0.0013). Finally, only 2.3% of opioid-naïve patients of the entire cohort became chronic opioid users, there was no difference in the incidence of chronic use by opioid discharge status.
Optimized opioid sparing ERATS protocols are highly effective in reducing opioid prescription on the day of discharge. We observed a very low rate of new persistent or chronic opioid use in our cohort, further highlighting the role ERATS protocols in combating the opioid epidemic.