The Impact of a Narcotic-Sparing Enhanced Recovery Protocol on Postoperative Narcotic Use following Colectomy

In the United States, 37% of all opioids are prescribed in the surgical setting. Among those addicted to narcotics, many report initial exposure in the postoperative period.We aimed to assess the impact of a narcotic-sparing enhanced recovery after surgery protocol on postoperative narcotic use by patients and to assess its impact on the narcotic prescribing practices of physicians.Data regarding consecutive narcotic-naïve patients who underwent an elective inpatient abdominal colorectal surgical procedure from January 2013 to August 2017 were retrospectively reviewed.Patients were divided into 2 cohorts: pre-implementation (2013-2015) and post-implementation (2015-2017) of the enhanced recovery after surgery protocol.Elective inpatient abdominal colorectal surgery patients at University of Florida Health.Primary outcome measure was 30-day postoperative narcotic use (inpatient and outpatient). Other outcomes measured included pain scores, time to diet institution, length of hospital stay, cost of hospitalization, and postoperative complications.Baseline characteristics were similar between the pre- (n = 537) and post-protocol (n = 790) groups. Protocol implementation was associated with a decrease in total 30-day postoperative narcotic amount used by patients (2481 mg vs 31 mg morphine equivalents, p = 0.05), inpatient patient-controlled analgesia use (63% vs 0.5%, p0.00001; dosage 1254 mg vs 5 mg), inpatient on-demand oral narcotic use (90% vs 32%, p = 0.001; dosage 47 mg vs 5 mg), and outpatient narcotic amount used (46 mg vs 6 mg, p = 0.001). Average pain scores were similar.Retrospective nature of the study and possible underestimation of pre- and postoperative narcotic use were limitations to the study findings.Implementation of a narcotic-sparing enhanced recovery after surgery protocol was associated with a decrease in both inpatient and 30-day outpatient postoperative narcotic use. Variation in resident physician prescribing practices suggests the need for ongoing education to accompany these protocols. See Video Abstract at http://links.lww.com/DCR/B936.