A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use.

Szczegóły
Abstrakt

Tytuł:: A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use.
Autorzy:: Reif de Paula T; Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.
Nemeth SK; Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York.
Kurlansky PA; Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York.
Simon HL; Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY.
Miller LK; Department of Anesthesia, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.
Keller DS; Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.
Źródło:: Annals of surgery [Ann Surg] 2022 Jan 01; Vol. 275 (1), pp. e22-e29.
Typ publikacji:: Journal Article; Randomized Controlled Trial
Język:: English
Imprint Name(s):: Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins
MeSH Terms:: Enhanced Recovery After Surgery*
Patient Acceptance of Health Care*
Digestive System Surgical Procedures/*methods
Opioid-Related Disorders/*prevention & control
Pain Management/*methods
Pain, Postoperative/*drug therapy
Rectal Diseases/*surgery
Adult ; Analgesics, Opioid/therapeutic use ; Anus Diseases/surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/diagnosis ; Patient Satisfaction ; Prospective Studies ; Single-Blind Method
References:: Kenan K, Mack K, Paulozzi L. Trends in prescriptions for oxycodone and other commonly used opioids in the United States, 2000-2010. Open Med 2012; 6:e41–e47.
Centers for Disease Control and Prevention CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017. Available at: http://wonder.cdc.gov . Last accessed May 2020.
Hedegaard H, Warner M, Miniño AM. Drug Overdose Deaths in the United States, 1999-2016. NCHS Data Brief. 20171-8.
Paulozzi LJ, Jones CM, Mack KA, et al. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep 2011; 60:1487–1492.
Center for Behavioral Health Statistics and Quality. (2017). 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
Wilson N, Kariisa M, Seth P, et al. Drug and opioid-involved overdose deaths - United States, 2017-2018. MMWR Morb Mortal Wkly Rep 2020; 69:290–297.
American Medical Association.;1; Issue brief: Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic. Issued October 6, 2020. Available at: https://www.ama-assn.org/system/files/2020-10/issue-brief-increases-in-opioid-related-overdose.pdf . Last accessed June 2020.
Florence CS, Zhou C, Luo F, et al. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 2016; 54:901–906.
The White House Council of Economic Advisers. Council of Economic Advisers Report: the Underestimated Cost of the Opioid Crisis. Issued November 20, 2017. Available at: https://www.whitehouse.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis/?utm_source=link . Last accessed May 2020.
Kessler ER, Shah M, Gruschkus SK, et al. Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy 2013; 33:383–391.
Lee JS, Hu HM, Edelman AL, et al. New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol 2017; 35:4042–4049.
Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017; 152:1–9.
Carroll I, Barelka P, Wang CK, et al. A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg 2012; 115:694–702.
Brandal D, Keller MS, Lee C, et al. Impact of enhanced recovery after surgery and opioid-free anesthesia on opioid prescriptions at discharge from the hospital: a historical-prospective study. Anesth Analg 2017; 125:1784–1792.
Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 2017; 152:691–697.
Joshi GP. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North America 2005; 23:185–202.
Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth 2015; 62:203–218.
Carmichael JC, Keller DS, Baldini G, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the american society of colon and rectal surgeons and society of american gastrointestinal and endoscopic surgeons. Dis Colon Rectum 2017; 60:761–784.
Swarup A, Mathis KA, Hill MV, et al. Patterns of opioid use and prescribing for outpatient anorectal operations. J Surg Res 2018; 229:283–287.
Billingham SA, Whitehead AL, Julious SA. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Med Res Methodol 2013; 13:1–6.
Gloth FM, Scheve AA, Stober CV, et al. The Functional Pain Scale: reliability, validity, and responsiveness in an elderly population. J Am Med Dir Assoc 2001; 2:110–114.
EuroQoL Group. Available at: https://euroqol.org/eq-5d-instruments/eq-5d-3l-about . Last accessed June 2020.
Rose KR, Christie BM, Block LM, et al. Opioid prescribing and consumption patterns following outpatient plastic surgery procedures. Plast Reconstr Surg 2019; 143:929–938.
Rodgers J, Cunningham K, Fitzgerald K, et al. Opioid consumption following outpatient upper extremity surgery. J Hand Surg Am 2012; 37:645–650.
Bates C, Laciak R, Southwick A, et al. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol 2011; 185:551–555.
Harris K, Curtis J, Larsen B, et al. Opioid pain medication use after dermatologic surgery: a prospective observational study of 212 dermatologic surgery patients. JAMA Dermatol 2013; 149:317–321.
Harbaugh CM, Lee JS, Hu HM, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics 2018; 141:1–9.
Hall MJ, Schwartzman A, Zhang J, et al. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. Natl Health Stat Report 2017; 102:1–15.
Schirle L, Stone AL, Morris MC, et al. Leftover opioids following adult surgical procedures: a systematic review and meta-analysis. Syst Rev 2020; 9:1–15.
Lu PW, Fields AC, Andriotti T, et al. Opioid prescriptions after hemorrhoidectomy. Dis Colon Rectum 2020; 63:1118–1126.
Van Backer JT, Jordan MR, Leahy DT, et al. Preemptive analgesia decreases pain following anorectal surgery: a prospective, randomized, double-blinded, placebo-controlled trial. Dis Colon Rectum 2018; 61:824–829.
Parrish AB, O’Neill SM, Crain SR, et al. An enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery reduced postoperative pain and unplanned returns to care after discharge. World J Surg 2018; 42:1929–1938.
Hartford LB, Murphy PB, Gray DK, et al. The Standardization of Outpatient Procedure (STOP) Narcotics after anorectal surgery: a prospective non-inferiority study to reduce opioid use. Tech Coloproctol 2020; 24:563–571.
Zaveri S, Nobel TB, Khetan P, et al. Risk of chronic opioid use in opioid-naïve and non-naïve patients after ambulatory surgery. J Gastrointest Surg 2020; 24:688–694.
Alam A, Gomes T, Zheng H, et al. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med 2012; 172:425–430.
Sun EC, Darnall BD, Baker LC, et al. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 2016; 176:1286–1293.
Yajnik M, Hill JN, Hunter OO, et al. Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery. Patient Educ Couns 2019; 102:383–387.
Brown CR, Chen Z, Khurshan F, et al. Development of persistent opioid use after cardiac surgery. JAMA Cardiol 2020; 5:889–886.
Martin LW, Sarosiek BM, Harrison MA, et al. Implementing a thoracic enhanced recovery program: lessons learned in the first year. Ann Thorac Surg 2018; 105:1597–1604.
Hill MV, Stucke RS, McMahon ML, et al. An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg 2018; 267:468–472.
Substance Nomenclature:: 0 (Analgesics, Opioid)
Entry Date(s):: Date Created: 20201222 Date Completed: 20220120 Latest Revision: 20230923
Update Code:: 20240105
DOI:: 10.1097/SLA.0000000000004701
PMID:: 33351458
: Czasopismo naukowe

Background: Anorectal cases may be a common gateway to the opioid epidemic. Opioid reduction is inherent in enhanced recovery after surgery (ERAS) protocols, but little work has evaluated ERAS in these cases.
Objective: To determine if ERAS could reduce postoperative opioid utilization in ambulatory anorectal surgery without sacrificing patient pain or satisfaction.
Methods: A randomized controlled trial assigned ambulatory anorectal patients to ERAS (experimental) or routine care (surgeon's choice) for pain management (control) over 30-days postoperatively. Primary outcome was overall days of opioid use. Secondary outcomes included pain and satisfaction scores over multiple time points and new persistent opioid use. The Visual Analog Scale, Functional Pain Scale, and EQ-5D-3L measured patient-reported pain and satisfaction. Univariate analysis compared outcomes overall and at individual time points. Two-way mixed ANOVA evaluated pain and satisfaction measures between groups and over time.
Results: Thirty-two patients were randomized into each arm (64 total). The control group consumed significantly more opioids after discharge (median 121.3MME vs 23.5MME, P < 0.001). Significantly more control patients requested additional narcotics (P = 0.004), made unplanned calls (P = 0.009), and had unplanned clinic visits (P = 0.003). The control group had significantly more days on opioids (mean 14.4 vs 2.2, P < 0.001). Three control patients (9.4%) versus no experimental patients had new persistent opioid use. The mean global health, EQ5D-3L, Visual Analog Scale, and Functional Pain scores were comparable between groups over time.
Conclusions: An ERAS protocol in ambulatory anorectal surgery is feasible, and resulted in reduced opioid use, and healthcare utilization, with no difference in pain or patient satisfaction. This challenges the paradigm that extended opioids are needed for effective postoperative pain management.
Competing Interests: The authors report no conflicts of interest.
(Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

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