Perioperative medicine & outcomes
Impact of a Multidisciplinary Institution-Wide Enhanced Surgical Recovery Framework on Perioperative Opioid Use: A Retrospective Cohort Study of 49,394 Patients
Authors' conclusion
System-wide implementation of an ESR framework was associated with lower perioperative opioid use without compromising pain control. Variation in MMA approach across individual protocols and discharge disposition groups highlights the value of multidisciplinary ESR programs in promoting effective and standardized, yet also customized, perioperative pain management practices.
Study context
- Population
- Patients with eligible ambulatory and inpatient surgical procedures 2 years prior to and after enhanced surgical recovery (ESR) implementation at a large academic medical centerBase 14,607 · post-ESR 34,787
- Participants
- 49,394 patients
- Exposure
- ESR adoption vs base, by discharge disposition
- ESRn = 34,787
- Basen = 14,607
- Outcome
- Inpatient OME per day, POD ≥ 2 discharge
Methodological detailsinstitution-wide, 10-year span, segmented regression analyses
- Institution-wide
- 10-year span
- Segmented regression analyses
Main finding
As reported in the abstract
Base
50.5
median · IQR 27.3–83.7
ESR
36.3
median · IQR 20.0–60.5
P < 0.0001
Observational data: associations, not effects.
Further findings
MMA use, same day discharge
P < 0.0001
MMA use, POD 1 discharge
P < 0.0001
MMA use, POD ≥2 discharge
P < 0.0001
Median
| Outcome | Base | ESR | P value |
|---|---|---|---|
| Total outpatient OME prescribed within 30 days, POD ≥ 2 discharge | 300.0 (IQR 150.0–600.0) | 150.0 (IQR 90.0–225.0) | P < 0.0001 |
- Total outpatient oral morphine equivalency (OME) prescribed within 30 days, POD ≥ 2 discharge — Base 300.0 [150.0-600.0], ESR 150.0 [90.0-225.0], P <
- .0001
Maximum pain scores
- Maximum pain scores before and after ESR implementation remained stable
Segmented regression of opiate use and MMA over time
- Downward trends in opiate use beginning during the planning phase of ESR with additional decreases temporally aligned with protocol initiation
- Significantly increased MMA in all discharge groups since the start of ESR
Original publication
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