A Multidisciplinary Opioid-Reduction Pathway for Robotic Prostatectomy: Outcomes at Year One

Abstract

Abstract Background: Opioid use has come under increasing scrutiny, driven in part by the opioid crisis and growing concerns that up to 6% of opioid-naïve patients may become chronic opioid users. This has resulted in a revaluation of perioperative practice. For this reason, we implemented a multidisciplinary pathway to reduce perioperative opioid usage through education and standardization of practice. Methods: A single centre retrospective evaluation was performed after one year, comparing the outcomes to those of the two years prior to pathway implementation. Comparisons were made between pre- vs. post pathway change by 2:1 propensity matching between cohorts. Univariate linear regression models were created using demographic variables with those that were p<0.15 included in the final model and using post-operative opioid use (in oral morphine equivalents, OME) as the primary outcome. Results: We found that intraoperative opioid use was significantly decreased 38.2mg(28.3) vs. 18.0mg(40.4) oral morphine equivalents (OME), p<.001, as was post-operative opioid use for the duration of the hospitalization, 46.3mg(49.5) vs. 35.49mg(43.7) OME, p=0.002. In subgroup analysis of those that received some intraoperative opioids (n= 152) and those that received no opioids (n=34), we found that both groups required fewer opioids in the post-operative period 47.0mg(47.7) vs. 32.4mg(40.6) OME; p=0.001; +intraoperative opioids ; 62.4mg(62.9) vs. 35.8mg(27.7) OME; p=0.13; -intraoperative opioids. Time to discharge from the PACU was reduced in both groups 215min(199) vs. 167min(122); p<0.003; +intraoperative opioids and 253min(270) vs. 167min(105); p=0.028; -intraoperative opioids. The duration of time until meeting discharge criteria from PACU was 221min(205) vs. 170min(120); p=0.001. Hospital length of stay (LOS) was significantly reduced 1.4 days(1.3) vs. 1.2 days(0.8); p=0.005. Both sub-groups demonstrated reduced hospital LOS 1.5 days(1.4) vs. 1.2 days(0.8); p=0.0047; +intraoperative opioids and 1.7 days(1.6) vs. 1.3 days(0.9); p=0.0583; -intraoperative opioids. Average pain scores during PACU admission and Post-PACU until discharge, were not statistically different between cohorts. Conclusions: These findings underscore the effectiveness of a multidisciplinary approach to reduce opioids. Furthermore, it demonstrates improved patient outcomes as measured by both shorter PACU and hospital length of stay, in addition to almost 50% reduction in perioperative opioid use.