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Enhanced recovery after surgery (ERAS) protocols significantly reduced outpatient opioid use following breast reconstruction surgery. ERAS protocols also maintained comparable pain control, suggesting broader benefits beyond inpatient care.

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Area of Science:

  • Surgical Recovery Protocols
  • Pain Management
  • Public Health

Background:

  • Enhanced Recovery After Surgery (ERAS) protocols are established for inpatient benefits.
  • Limited data exists on ERAS impact on outpatient recovery and opioid use post-discharge.
  • Patients may experience a rebound effect in pain and opioid needs after leaving the hospital.

Purpose of the Study:

  • To investigate the effect of ERAS protocol implementation on outpatient opioid consumption.
  • To assess the impact of ERAS on patient recovery in the post-discharge period.
  • To determine if ERAS protocols can help mitigate the prescription opioid crisis.

Main Methods:

  • Retrospective review of patients undergoing abdominally based microsurgical breast reconstruction.
  • Comparison of opioid use before and after ERAS protocol implementation.
  • Opioid use determined via a statewide prescription reporting system, adhering to state laws limiting prescriptions to 7 days.

Main Results:

  • Total outpatient opioid use (morphine milligram equivalents) was significantly lower in the ERAS group (337.5) compared to the pre-ERAS group (668.8; p=0.016).
  • This reduction was most pronounced in the first postoperative week (p=0.044), with usage gradually converging over time.
  • Pain scores were comparable between the ERAS and pre-ERAS groups, despite reduced opioid consumption in the ERAS cohort.

Conclusions:

  • ERAS protocol benefits extend into the outpatient setting, supporting their wider adoption.
  • ERAS protocols can facilitate patient recovery and potentially reduce reliance on prescription opioids.
  • Implementation of ERAS may play a role in addressing the national prescription opioid abuse epidemic.