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Area of Science:

  • Thoracic Surgery
  • Pain Management
  • ERAS Protocols

Background:

  • Enhanced Recovery After Surgery (ERAS) is crucial for thoracic surgery outcomes.
  • Opioid-sparing analgesia is a key ERAS component, but its impact on patients with prior opioid use requires clarification.
  • Understanding ERAS effects on new persistent opioid use (NPOU) is essential.

Purpose of the Study:

  • To evaluate ERAS protocol effects on opioid use in pulmonary resection patients.
  • To identify factors associated with new persistent opioid use (NPOU) post-pulmonary resection.
  • To compare ERAS impact based on preoperative opioid exposure.

Main Methods:

  • Utilized a prospectively maintained database of pulmonary resection patients.
  • Linked surgical data with regional prescription drug monitoring programs.
  • Stratified patients into opioid-naive and non-naive groups based on 12-month preoperative opioid prescription history.

Main Results:

  • ERAS reduced total inpatient and discharge opioid doses (morphine milligram equivalents) for both naive and non-naive groups.
  • Opioid-naive patients experienced shorter hospital stays and chest tube duration with ERAS.
  • ERAS implementation did not alter the 10.9% rate of new persistent opioid use (NPOU) in opioid-naive patients.

Conclusions:

  • ERAS protocols effectively reduce overall opioid consumption in pulmonary resection patients, irrespective of prior opioid use.
  • A significant proportion of opioid-naive patients developed new persistent opioid use (NPOU) post-ERAS, with similar postoperative courses.
  • Further research is needed to identify NPOU risk factors and personalize pain management strategies for thoracic surgery patients.