Perioperative medicine & outcomes
Reducing Chronic Opioid Use: Long-term Impacts of Enhanced Recovery After Mastectomy Protocols
Main finding · Chronic opioid useResult — go to the resultOdds ratio 0.57 95% CI 0.42–0.76Authors' conclusion
ERAS protocols for mastectomy patients with or without IBR are associated with decreases in chronic opioid use, without concomitant increases in chronic sedative use.
Study context
- Population
- Patients undergoing mastectomy with or without implant-based breast reconstruction (IBBR), single institution, 2013–2019
- Participants
- 756 patients
- Exposure
- Enhanced Recovery After Surgery (ERAS) vs pre-ERAS
- pre-ERASn = 405reference
- ERASn = 351
- Outcome
- Chronic opioid use (beyond 90 days after surgery)
Methodological detailssingle-centre, before-after (ERAS implemented February 2017)
- Single-centre
- Before-after (ERAS implemented February 2017)
Main finding
Chronic opioid use
Odds ratio
0.57
95% CI 0.42–0.76
ERAS vs pre-ERAS
OR 0.57 (95% CI 0.42–0.76)
As reported in the abstract
Observational data: associations, not effects.
Further findings
Chronic opioid use, opioid-naive patients (subgroup)
P = 0.024
Chronic opioid use, opioid-tolerant patients (subgroup)
P = 0.002
Factors associated with chronic opioid use (multivariable logistic regression)
| OR (95% CI) | ||
|---|---|---|
| Subcutaneous implants (IBBR patients) | 0.31 (0.20–0.48) | |
| Bilateral surgery | 1.54 (1.14–2.08) | |
| 2-stage reconstruction | 9.78 (5.94–16.09) | |
| Higher PACU pain scores | 1.09 (1.03–1.14) | |
| >150 discharge OMEs | 2.63 (1.48–4.68) | |
| 0.050.21520Odds ratio (log scale) |
Chronic sedative use
- No increase in chronic sedative use post-ERAS
Original publication
Reducing Chronic Opioid Use: Long-term Impacts of Enhanced Recovery After Mastectomy Protocols. Ann Surg. Published 17 May 2024. doi:10.
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