Postoperative Narcotic Use In Patients With Ovarian Cancer On An Enhanced Recovery After Surgery (Eras) Pathway

In light of the current opioid epidemic, the medical community is exploring potential means to reduce postoperative narcotic use. This retrospective cohort study aimed to assess the impact of a gynecologic oncology enhanced recovery after surgery (ERAS) pathway on postoperative need for narcotics in the first 3 months after an open surgery in patients with ovarian cancer. Both cohorts included subjects recruited at the University of Washington, where an ERAS pathway for gynecologic oncology was implemented May 1, 2016. The control cohort included patients with ovarian cancer undergoing surgery in 2014 prior, whereas the second cohort included patients treated following the implementation of the ERAS pathway. Patients in the ERAS pathway received counseling on postoperative multimodal pain treatment with an emphasis on early mobility as well as acetaminophen and gabapentin preoperatively. At the conclusion of the surgery, patients in the ERAS cohort received fascial and subdermal long-acting liposomal bupivacaine, scheduled acetaminophen and ketorolac for 24 hours, followed by scheduled ibuprofen, and were given oral oxycodone or hydromorphone for narcotic pain management. The Washington State Prescription Monitoring Program was used to determine the number of narcotic prescriptions subjects filled in the 3 months postoperatively.A total of 42 patients underwent open surgery for ovarian cancer in 2014 (pre-ERAS), whereas 94 underwent open surgery on the ERAS pathway (ERAS). Patients on the ERAS pathway spent an average of 2.5 fewer days in the hospital with no difference in readmission. Compared with the pre-ERAS, the ERAS patients used less narcotics in the 24 hours before discharge (74.0 MME vs 25.8 MME, respectively, P = 0.002), filled prescriptions for lower MME quantity at discharge (519.9 MME vs 339.7 MME, respectively, P = 0.011), and filled fewer additional narcotic prescriptions after discharge (52.4% vs 29.4%, respectively, P = 0.012). The ERAS cohort filled prescriptions for 55% less MME compared with the pre-ERAS cohort in the 3 months postoperatively (492.1 MME vs 1101.4 MME, respectively, P < 0.001).This study demonstrated a reduction in narcotic use in the 24 hours before discharge and 3 months postoperatively for patients receiving open surgery for ovarian cancer with pain management directed under an ERAS pathway.