Tran-McCaslin M, Basam M, Rudikoff A, Thuraisingham D, McLemore EC. Reduced Opioid Use and Prescribing in a Same Day Discharge Pilot Enhanced Recovery Program for Elective Minimally Invasive Colorectal Surgical Procedures During the COVID-19 Pandemic.
Am Surg 2022;
88:2572-2578. [PMID:
35771192 PMCID:
PMC9253719 DOI:
10.1177/00031348221109467]
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Abstract
Purpose
Enhanced recovery pathways (ERPs) are associated with reduced complications
and length of stay. The validation of the I-FEED scoring system, advances in
perioperative anesthesia, multimodal analgesia, and telehealth remote
monitoring have resulted in further evolution of ERPs setting the stage for
same day discharge (SDD). Pioneers and early adopters have demonstrated the
safety and feasibility of SDD programs. The aim of this study is to evaluate
the impact of a pilot SDD ERP on patient self-reported pain scoring and
narcotic usage.
Methods
A quality improvement pilot program was conducted to assess the impact of a
SDD ERP on post-operative pain score reporting and opioid use in healthy
patients undergoing elective colorectal surgery as an alternative to
post-operative hospitalization during the COVID-19 pandemic (May
2020-December 2021). Patients were monitored remotely with daily telephone
visits on POD 1-7 assessing the following variables: I-FEED score, pain
score, pain management, bowel function, dietary advancement, any
complications, and/or re-admissions.
Results
Thirty-seven patients met the highly selective eligibility criteria for
“healthy patient, healthy anastomosis.” SDD occurred in 70%. The remaining
30% were discharged on POD 1. Mean total narcotic usage was 5.2 tablets of
5 mg oxycodone despite relatively high reported pain scores.
Conclusions
In our initial experience, SDD is associated with significantly lower patient
narcotic utilization for postoperative pain management than hypothesized.
This pilot SDD program resulted in a change in clinical practice with
reduction of prescribed discharge oxycodone 5 mg quantity from #40 to #10
tablets.
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