To fight the opioid epidemic, ob/gyns, like all physicians, are looking for ways to help prevent substance use disorders. One recent study, published in Obstetrics & Gynecology, sheds light on the role that enhanced recovery after surgery (ERAS) programs may play in this effort.
For the study, the researchers compared perioperative outcomes with a focus on intraoperative and postoperative opioid consumption in women undergoing surgery before and after implementation of an ERAS program. The ERAS program was at the University of Texas MD Anderson Cancer Center. All 607 patients in the study underwent open gynecologic surgery, 74 before the ERAS pathway was in use and 533 after that point. Median patient age was 58 (range 18-85 years).
The authors found that patients in the ERAS pathway had a 72% reduction in median opioid consumption from postoperative Day 0 to Day 3 compared to the pre-ERAS patients. In addition, 86 patients (16%) on the ERAS pathway were opioid-free from the first to third postoperative day compared to none of the pre-ERAS patients.
Furthermore, despite the lower usage of opioids in the ERAS group, pain scores were not significantly higher (P = .80). In the ERAS group, fatigue during the hospital stay was also lower (P = .01), there was less interference with walking during hospitalization (P = .003), and less total interference with work, activity, walking, enjoyment of life, mood, and relations with others during hospitalization (P = .008).
Median length of stay after surgery was 25% shorter in patients in the ERAS group (3 vs 4 days, P < .001).Following hospital discharge, those patients had no or mild interference with walking at a median of 5 days (95% CI 2.2-7.8 days) compared to 13 days (95% CI 4.5-21.5 days, P = .003) in the pre-ERAS group.
The authors believe their findings illustrate the benefits of implementing ERAS with gynecologic procedures. Given the current opioid epidemic, their findings that decreasing opioid use during postoperative recovery did not affect pain scores or length of stay are particularly promising. They noted, however, that ERAS programs must be continuously audited for performance to ensure that patient care and ERAS pathway compliance remain high.