HealthDay News — Opioid-free discharge is feasible after pancreatic surgery, according to a study published online Sept. 6 in JAMA Surgery.
Artem Boyev, D.O., from The University of Texas MD Anderson Cancer Center in Houston, and colleagues analyzed the outcomes of two iterative risk-stratified pancreatectomy clinical pathway updates in a cohort study including 832 adult patients who underwent pancreatic resection. The patients comprised three sequential pathway cohorts: Version (V)1 of the pathway established a baseline and reduced length of stay; V2 updated education handouts, limited intravenous opioids, suggested a nonopioid bundle, and implemented the 5x multiplier to calculate discharge volume; and V3 required the nonopioid bundle as default in the recovery room (363, 229, and 240 patients, respectively).
The researchers found that from V1 to V3, there was an increase in early nonopioid bundle administration. A decrease was seen in total inpatient oral morphine equivalents (OME) from V1 to V2 to V3 (median of 290 to 184 to 129 mg, respectively). From V1 to V2 and V3, the discharge OME decreased from a median of 150 to 25 to 0 mg, respectively. There was an increase in the percentage of patients discharged opioid-free from 7.2 to 52.5 percent from V1 to V3; in V3, 77.9 percent were discharged with 50 mg OME or less. In all cohorts, the median pain scores remained 3 or lower, with no differences in postdischarge refill requests.
“Our enhanced recovery program, which includes generalizable protocols to reduce reliance on opioid medications, is the first to demonstrate continuous decreases in opioid use and distribution after pancreatic surgery,” coauthor Ching-Wei D. Tzeng, M.D., also from The University of Texas MD Anderson Cancer Center, said in a statement.
One author disclosed ties to PanTher.