• Lydia R Maurer, El MohebMohamadMCenter for Outcomes and Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Trauma, Emergency Surgery, and Surgical Critical Care, Ma, Elena Cavallo, Donna M Antonelli, Pamela Linov, Sarah Bird, Heather R Faulkner, Marcela Del Carmen, Motaz Qadan, Cristina R Ferrone, KaafaraniHaytham M AHMACenter for Outcomes and Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.Massachusetts General Physicians Organization, Massachusetts G, Rachel Sisodia, and Dan B Ellis.
• Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
• Ann. Surg. 2023 Feb 1; 277 (2): e287e293e287-e293.

ObjectiveWe aimed to compare discharge opioid prescriptions pre- and post-ERAS implementation.Summary Of Background DataERAS programs decrease inpatient opioid use, but their relationship with postdischarge opioids remains unclear.MethodsAll patients undergoing hysterectomy between October 2016 and November 2020 and pancreatectomy or hepatectomy between April 2017 and November 2020 at 1 tertiary care center were included. For each procedure, ERAS was implemented during the study period. PSM was performed to compare pre - versus post-ERAS patients on discharge opioids (number of pills and oral morphine equivalents). Patients were matched on age, sex, race, payor, American Society of Anesthesiologists score, prior opioid use, and procedure. Sensitivity analyses in open versus minimally invasive surgery cohorts were performed.ResultsA total of 3983 patients were included (1929 pre-ERAS; 2054 post-ERAS). Post-ERAS patients were younger (56.0 vs 58.4 years; P < 0.001), more often female (95.8% vs 78.1%; P < 0.001), less often white (77.2% vs 82.0%; P < 0.001), less often had prior opioid use (20.1% vs 28.1%; P < 0.001), and more often underwent hysterectomy (91.1% vs 55.7%; P < 0.001). After PSM, there were no significant differences between cohorts in baseline characteristics. Matched post-ERAS patients were prescribed fewer opioid pills (17.4 pills vs 22.0 pills; P < 0.001) and lower oral morphine equivalents (129.4 mg vs 167.6 mg; P < 0.001) than pre-ERAS patients. Sensitivity analyses confirmed these findings [open (18.8 pills vs 25.4 pills; P < 0.001 \ 138.9 mg vs 198.7 mg; P < 0.001); minimally invasive surgery (17.2 pills vs 21.1 pills; P < 0.001 \ 127.1 mg vs 160.1 mg; P < 0.001).ConclusionsPost-ERAS patients were prescribed significantly fewer opioids at discharge compared to matched pre-ERAS patients.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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