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Comparative Study
. 2019 Jul;166(1):22-27.
doi: 10.1016/j.surg.2019.02.008. Epub 2019 May 15.

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

Heather A Lillemoe  1 , Rebecca K Marcus  1 , Ryan W Day  1 , Bradford J Kim  1 , Nisha Narula  1 , Catherine H Davis  1 , Vijaya Gottumukkala  2 , Thomas A Aloia  3
Affiliations
Comparative Study

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

Heather A Lillemoe et al. Surgery. 2019 Jul.

Abstract

Background: Pathways of enhanced recovery in liver surgery decrease inpatient opioid use; however, little data exist regarding their effect on discharge prescriptions and post-discharge opioid intake.

Methods: For consecutive patients undergoing liver resection from 2011-2018, clinicopathologic factors were compared between patients exposed to enhanced recovery vs. traditional care pathways. Multivariable analysis was used to determine factors predictive for traditional opioid use at the first postoperative follow-up. The enhanced recovery in liver surgery protocol included opioid-sparing analgesia, goal-directed fluid therapy, early postoperative feeding, and early ambulation.

Results: Of 244 cases, 147 enhanced recovery patients were compared with 97 traditional pathway patients. Enhanced recovery patients were older (median 57 years vs 52 years, P = .031) and more frequently had minimally invasive operations (37% vs 16%, P < .001), with fewer major complications (2% vs 9%, P = .011). Enhanced recovery patients were less likely to be discharged with a prescription for traditional opioids (26% vs 79%, P < .001) and less likely to require opioids at their first postoperative visit (19% vs 61%, P < .001) despite similarly low patient-reported pain scores (median 2/10 both groups, P = .500). On multivariable analysis, the traditional recovery pathway was independently associated with traditional opioid use at the first follow-up (odds ratio 6.4, 95% confidence interval 3.5-12.1; P < .001).

Conclusion: The implementation of an enhanced recovery in liver surgery pathway with opioid-sparing techniques was associated with decreased postoperative discharge prescriptions for opioids and outpatient opioid use after oncologic liver surgery, while achieving the same level of pain control. For this and other populations at risk of persistent opioid use, enhanced recovery strategies can eliminate excess availability of opioids.

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Conflict of interest statement

Financial Disclosures: All authors (Drs. Lillemoe, Marcus, Day, Kim, Narula, Davis, Gottumukkala, Aloia) report no biomedical financial interests or potential conflicts of interest associated with this study.

Figures

Figure 1
Figure 1
Study Patient Inclusion [ERILS, Enhanced Recovery in Liver Surgery]
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