Opioid prescribing practices during implementation of an enhanced recovery program at a tertiary care hospital

Enhanced recovery programs have demonstrated a decrease in opioid use in hospitals where patients have undergone colorectal surgery. This study is to investigate whether similar decreases in opioid prescribing are achieved at discharge and postdischarge.

Patients undergoing colorectal surgery November 2014-November 2016 were reviewed. Postdischarge opioid prescribing was quantified in morphine milligram equivalents at time of discharge, 30 days postdischarge, and 60 days postdischarge. Linear regression models were used to examine factors predictive of opioid prescribing.

A total of 324 patients treated on enhanced recovery program protocol and 451 patients off enhanced recovery program protocol were reviewed. Enhanced recovery program patients had shorter lengths of stay: 6.74 ± 5.3 vs 9.0 ± 7.0 days (mean ± standard deviation; P < .0001). At discharge, enhanced recovery program patients were prescribed higher amounts of opioids (morphine milligram equivalent 307.4 ± 286.3 vs 242.5 ± 243.1 [mean ± SD]; P = .001) and were more likely to receive additional opioid prescriptions in the next 30 days (28.7% vs 18.85%; P = .0013). Linear regression models suggest that preoperative opioid use, age, and treatment on enhanced recovery program protocol were predictive of opioid prescribing (morphine milligram equivalent) at time of discharge.

Enhanced recovery program patients received more opioid prescribing (morphine milligram equivalent) at discharge and within the first 30 days postdischarge. Alternative confounding variables require further investigation.