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

Autor:	Marie, Tran-McCaslin, Motahar, Basam, Andrew, Rudikoff, Dhilan, Thuraisingham, Elisabeth C, McLemore
Rok vydání:	2022
Předmět:	Narcotics Pain Postoperative COVID-19 General Medicine Opioid-Related Disorders Patient Discharge Analgesics Opioid Elective Surgical Procedures Humans Minimally Invasive Surgical Procedures Colorectal Neoplasms Pandemics Oxycodone Retrospective Studies
Zdroj:	The American Surgeon. 88:2572-2578
ISSN:	1555-9823 0003-1348
DOI:	10.1177/00031348221109467
Popis:	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.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d5b7deb9a4605d83121e381638070182 https://doi.org/10.1177/00031348221109467 Zobrazit plný text záznamu