Impact of an enhanced recovery after surgery program with a multimodal analgesia care pathway on opioid prescribing and clinical outcomes for patients undergoing colorectal surgery

Abstract

Background

Opioids are a mainstay for acute pain management, but their side effects can adversely impact patient recovery. Multimodal analgesia (MMA) is recommended for treatment of postoperative pain and has been incorporated in enhanced recovery after surgery (ERAS) protocols. The objective of this quality improvement study was to implement an MMA care pathway as part of an ERAS program for colorectal surgery and to measure the effect of this intervention on patient outcomes and costs.

Methods

This pre-post study included 856 adult inpatients who underwent an elective colorectal surgery at three hospitals within an integrated healthcare system. The impact of ERAS program implementation on opioid prescribing practices, outcomes, and costs was examined after adjusting for clinical and demographic confounders.

Results

Improvements were seen in MMA compliance (34.0% vs 65.5%, P < 0.0001) and ERAS compliance (50.4% vs 57.6%, P < 0.0001). Reductions in mean days on opioids (4.2 vs 3.2), daily (51.6 vs 33.4 mg) and total (228.8 vs 112.7 mg) morphine milligram equivalents given during hospitalization, and risk-adjusted length of stay (4.3 vs 3.6 days, P < 0.05) were also observed.

Conclusions

Implementing ERAS programs that include MMA care pathways as standard of care may result in more judicious use of opioids and reduce patient recovery time.

Keywords:

• Colorectal surgery
• enhanced recovery after surgery
• multimodal analgesia
• opioid use

Disclosure statement/Funding

Dr. Wan is the Global Head of Evidence Generation and Data Sciences at Mallinckrodt Pharmaceuticals. Ms. Böing previously served as the Senior Manager for Health Economics and Outcomes Research (HEOR) and Real-World Evidence at Mallinckrodt Pharmaceuticals and is currently the Director of Global HEOR for Rare Disease at Ipsen. Dr. Collinsworth is currently a Senior Research Scientist at 3M. The other authors declare no potential conflicts of interest.