Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis

Abstract Introduction Enhanced recovery after surgery (ERAS) pathways have emerged as a promising strategy to reduce postoperative opioid use and decrease the risk of developing new persistent opioid use in surgical patients. However, the association between ERAS implementation and discharge opioid...

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Autores principales:	E. M. Langnas, Z. A. Matthay, A. Lin, M. W. Harbell, R. Croci, R. Rodriguez-Monguio, C. L. Chen
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Opioids Cesarean delivery Multimodal analgesia Oral morphine equivalents Postoperative pain Surgery RD1-811
Acceso en línea:	https://doaj.org/article/993ff01737c245749d0dab3ee7e0476e
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spelling	oai:doaj.org-article:993ff01737c245749d0dab3ee7e0476e2021-11-21T12:40:23ZEnhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis10.1186/s13741-021-00209-02047-0525https://doaj.org/article/993ff01737c245749d0dab3ee7e0476e2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13741-021-00209-0https://doaj.org/toc/2047-0525Abstract Introduction Enhanced recovery after surgery (ERAS) pathways have emerged as a promising strategy to reduce postoperative opioid use and decrease the risk of developing new persistent opioid use in surgical patients. However, the association between ERAS implementation and discharge opioid prescribing practices is unclear. Study design We conducted a retrospective observational quasi-experimental study of opioid-naïve patients aged 18+ undergoing cesarean delivery between February 2015 and December 2019 at a large academic center. An interrupted time series analysis (ITSA) was used to model the changes in pain medication prescribing associated with the implementation of ERAS to account for pre-existing temporal trends. Results Among the 1473 patients (out of 2249 total) who underwent cesarean delivery after ERAS implementation, 80.72% received a discharge opioid prescription vs. 95.36% at baseline. Pre-ERAS daily oral morphine equivalents (OME) on the discharge prescription decreased by 0.48 OME each month (p<0.01). There was a level shift of 35 more OME prescribed (p<0.01), followed by a monthly decrease of 1.4 OMEs per month after ERAS implementation (p<0.01). Among those who received a prescription, 61.35% received a total daily dose greater than 90 OME compared to 11.35% pre-implementation (p<0.01), while prescriptions with a total daily dose less than 50 OME decreased from 79.86 to 25.85% after ERAS implementation(p<0.01). Conclusion Although ERAS implementation reduced the overall proportion of patients receiving a discharge opioid prescription after cesarean delivery, for the subset of patients receiving an opioid prescription, ERAS implementation may have inadvertently increased the prescribing of daily doses greater than 90 OME. This finding highlights the importance of early and continued evaluation after new policies are implemented.E. M. LangnasZ. A. MatthayA. LinM. W. HarbellR. CrociR. Rodriguez-MonguioC. L. ChenBMCarticleOpioidsCesarean deliveryMultimodal analgesiaOral morphine equivalentsPostoperative painSurgeryRD1-811ENPerioperative Medicine, Vol 10, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Opioids Cesarean delivery Multimodal analgesia Oral morphine equivalents Postoperative pain Surgery RD1-811
spellingShingle	Opioids Cesarean delivery Multimodal analgesia Oral morphine equivalents Postoperative pain Surgery RD1-811 E. M. Langnas Z. A. Matthay A. Lin M. W. Harbell R. Croci R. Rodriguez-Monguio C. L. Chen Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
description	Abstract Introduction Enhanced recovery after surgery (ERAS) pathways have emerged as a promising strategy to reduce postoperative opioid use and decrease the risk of developing new persistent opioid use in surgical patients. However, the association between ERAS implementation and discharge opioid prescribing practices is unclear. Study design We conducted a retrospective observational quasi-experimental study of opioid-naïve patients aged 18+ undergoing cesarean delivery between February 2015 and December 2019 at a large academic center. An interrupted time series analysis (ITSA) was used to model the changes in pain medication prescribing associated with the implementation of ERAS to account for pre-existing temporal trends. Results Among the 1473 patients (out of 2249 total) who underwent cesarean delivery after ERAS implementation, 80.72% received a discharge opioid prescription vs. 95.36% at baseline. Pre-ERAS daily oral morphine equivalents (OME) on the discharge prescription decreased by 0.48 OME each month (p<0.01). There was a level shift of 35 more OME prescribed (p<0.01), followed by a monthly decrease of 1.4 OMEs per month after ERAS implementation (p<0.01). Among those who received a prescription, 61.35% received a total daily dose greater than 90 OME compared to 11.35% pre-implementation (p<0.01), while prescriptions with a total daily dose less than 50 OME decreased from 79.86 to 25.85% after ERAS implementation(p<0.01). Conclusion Although ERAS implementation reduced the overall proportion of patients receiving a discharge opioid prescription after cesarean delivery, for the subset of patients receiving an opioid prescription, ERAS implementation may have inadvertently increased the prescribing of daily doses greater than 90 OME. This finding highlights the importance of early and continued evaluation after new policies are implemented.
format	article
author	E. M. Langnas Z. A. Matthay A. Lin M. W. Harbell R. Croci R. Rodriguez-Monguio C. L. Chen
author_facet	E. M. Langnas Z. A. Matthay A. Lin M. W. Harbell R. Croci R. Rodriguez-Monguio C. L. Chen
author_sort	E. M. Langnas
title	Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
title_short	Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
title_full	Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
title_fullStr	Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
title_full_unstemmed	Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
title_sort	enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/993ff01737c245749d0dab3ee7e0476e
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Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis

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