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Effect of an Enhanced Recovery After Surgery Program on Opioid Use and Patient-Reported Outcomes

Meyer, Larissa A., MD, MPH; Lasala, Javier, MD; Iniesta, Maria D., MD, PhD; Nick, Alpa M., MD; Munsell, Mark F., MS; Shi, Qiuling, PhD; Wang, Xin Shelley, MD; Cain, Katherine E., PharmD; Lu, Karen H., MD; Ramirez, Pedro T., MD

doi: 10.1097/AOG.0000000000002735
Contents: Gynecologic Surgery: Original Research
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OBJECTIVE: To investigate the effect of an enhanced recovery after surgery (ERAS) program on perioperative outcomes with an emphasis on opioid consumption and patient-reported outcomes in the immediate and extended postoperative periods.

METHODS: We initiated our ERAS program as part of a quality improvement initiative in November 2014. We compared clinical outcomes among a cohort of 607 women undergoing open gynecologic surgery before or after implementation of ERAS. For 293 patients, patient-reported outcomes were compared using the MD Anderson Symptom Inventory-Ovarian Cancer.

RESULTS: Median age was 58 years (range 18–85 years). Median length of stay decreased by 25% for patients in the ERAS pathway (P<.001). Overall, patients in the ERAS group had a 72% reduction in median opioid consumption and 16% were opioid-free during admission up to postoperative day 3 (P<.001). There was no difference in pain scores (P=.80). Patients on ERAS reported less fatigue (P=.01), interference with walking (P=.003), and total interference (composite score of physical and affective measures) during hospitalization (P=.008). After discharge, those on the ERAS pathway demonstrated a significantly shorter median time to return to no or mild fatigue (10 vs 30 days, P=.03), mild or no interference with walking (5 vs 13 days, P=.003), and mild to no total interference (3 vs 13 days, P=.02). There were no significant differences in complications, rates of readmission, or reoperation between the pre- and post-ERAS groups.

CONCLUSION: Implementation of an ERAS program was associated with significantly decreased opioid use after surgery and improvement in key patient-reported outcomes associated with functional recovery after surgery without compromising pain scores.

Participation in an enhanced recovery program was associated with decreased intraoperative and postoperative opioid intake and improved functional recovery in the hospital and after discharge.

Departments of Gynecologic Oncology and Reproductive Medicine, Anesthesiology and Perioperative Medicine, Biostatistics, and Symptom Research, and the Division of Pharmacy, the University of Texas MD Anderson Cancer Center, Houston, Texas; Tennessee Oncology, Nashville, Tennessee; and the University of Tennessee Health Sciences Center, Memphis, Tennessee.

Corresponding author: Larissa A. Meyer, MD, MPH, Department of Gynecologic Oncology and Reproductive Medicine, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; email:

Larissa A. Meyer is supported by a NIH-NCI K07-CA201013 grant. This work was in part supported through a NIH-NCI P30 CA016672 core grant (Biostatistics Resource Group and Clinical Trials Support Resource).

Financial Disclosure Dr. Meyer has received research funding from AstraZeneca for unrelated research and has participated in an advisory board for Clovis Oncology. The other authors did not report any potential conflicts of interest.

Presented at the World Congress of Enhanced Recovery after Surgery and Perioperative Medicine Annual Meeting, May 9–12, 2015, Washington, DC; the International Meeting of the European Society of Gynaecological Oncology, October 24–27, 2015, Nice, France; and the Society of Gynecologic Oncology Annual Meeting on Women's Cancer, March 19–22, 2016, San Diego, California.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received March 09, 2018

Received in revised form May 04, 2018

Accepted May 10, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.