Home E-Weekly February 6, 2018

The Secret to Faster Discharge, Fewer Opioids

A new study suggests patients who undergo an enhanced recovery after surgery program (ERAS) leave the facility sooner after surgery.

EDUCATION The enhanced recovery program includes pre-op patient education to reduce length of stay and improve the quality of recovery.

Patients who are in enhanced recovery after surgery programs (ERAS) are discharged sooner and take fewer opioids, according to research presented at the American Society of Anesthesiologists Practice Management 2018 meeting.

ERAS programs use a variety of methods to ease the effects of surgery and facilitate early patient recovery. They are a key element of the Perioperative Surgical Home (PSH), in which a patient's surgical experience is fully coordinated and treated as a continuum of care.

Researchers analyzed the results, including length of stay and opioid use, of 621 colorectal or bariatric surgery patients who participated in an ERAS program. They compared those results to data they already had regarding the outcome of colorectal and bariatric surgery in non-ERAS patients.

As part of the program, patients did the following:

  • Underwent pre-operative patient education — first at the surgeon's office and then in the preadmission testing clinic.
  • Loaded up on carbohydrates, both the night before and 3 hours before surgery.
  • Took Alvimopan to help with bowel function.
  • Received transversus abdominal plane blocks to reduce the need for opioids following surgery.

Researchers from Providence Anesthesiology Associates in Charlotte, N.C., who conducted the study, found that, on average, colorectal patients in the ERAS program left the hospital after 2.05 days, as compared to 4.5 days for non-ERAS patients. Bariatric patients in the ERAS group stayed an average of .95 days, compared to 2.15 days for non-ERAS patients.

As well as length of stay, researchers found that patients in the ERAS groups also used fewer opioids and left PACU earlier than those not in the ERAS group.

They found an additional benefit in the case of colorectal surgery ERAS patients — costs were reduced by 20% per case.

Anna Merriman

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