Townsend WB, et al. Urology 2020.
OBJECTIVE: To measure differences in post-operative opioid usage and pain scores between pre- and post-Enhanced Recovery after Surgery (ERAS®) radical cystectomy (RC) patients in an effort to optimize outcomes.
STUDY DESIGN: We performed a retrospective cohort study from a single institution from January 1, 2015 to July 31, 2018 among 86 and 108 pre- and post-ERAS® RC patients. The primary endpoints were total mean opioid usage (Morphine Equivalent Daily Dosing or MEDD) and mean pain scores (Visual Analog Scale or VAS) on post-operative days (POD) 1-3. Secondary endpoints were number of opioid pills prescribed at discharge and within 30 days of discharge. Multivariable model selection was carried out with forward selection and backward elimination to identify variables associated with key outcomes.
RESULTS: Total mean usage of opioids and mean pain scores were significantly lower in post-ERAS® v. pre-ERAS® patients across POD 1-3, respectively (32.90 MEDD v 99.86 MEDD, p=<0.001; 3.51 v 4.17, p=0.003). The median number of opioid pills prescribed at discharge was significantly lower in the post-ERAS® group compared to pre-ERAS® (30 pills v 45 pills, p=0.046) as well as the median number opioid pills prescribed within 30 days of discharge (40 pills v 50 pills, p=0.001).
CONCLUSION: Our study suggests that a dedicated ERAS® protocol following RC might be superior to traditional, non-ERAS® methods in reducing post-operative opioid use and pain scores.