A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one

Area of Science:

• Anesthesiology and Perioperative Medicine
• Pain Management
• Health Services Research

Background:

• Growing concerns over chronic opioid use in opioid-naïve patients necessitate reevaluation of perioperative practices.
• The opioid crisis has intensified scrutiny on opioid prescribing, particularly in the post-operative setting.
• A significant percentage of patients (up to 6%) may develop chronic opioid use after surgery.

Purpose of the Study:

• To implement and evaluate a multidisciplinary pathway aimed at reducing perioperative opioid consumption.
• To assess the impact of standardized education and practice on opioid usage in the perioperative period.
• To compare patient outcomes before and after the implementation of the new pathway.

Main Methods:

• A single-centre retrospective study comparing one year post-pathway implementation with two years prior.
• 2:1 propensity matching was used to compare pre- and post-pathway cohorts.
• Univariate linear regression identified demographic variables for the final model, with post-operative opioid use (oral morphine equivalents, OME) as the primary outcome.

Main Results:

• Significant reductions were observed in both intraoperative (38.2 vs. 18.0 mg OME) and post-operative (46.3 vs. 35.49 mg OME) opioid use.
• PACU discharge time and overall hospital length of stay (LOS) were significantly reduced.
• Subgroup analyses confirmed reduced opioid use and LOS, with no statistically significant difference in patient-reported pain scores.

Conclusions:

• A multidisciplinary approach is effective in reducing perioperative opioid use.
• The pathway improved patient outcomes, including shorter PACU and hospital stays.
• Similar analgesia was maintained, as indicated by patient-reported pain scores, demonstrating the pathway's efficacy.