Early Recovery Protocols Effect the Opioid Prescriptions at Discharge After Major Urologic Cancer Surgery

ABSTRACT Introduction Early recovery after surgery (ERAS) protocols are designed limit the use of opioids during in-patient stay to facilitate recovery and early discharge. However, there are conflicting reports of opioids prescribed at discharge to these patients. We wished to evaluate the effect of early recovery efforts on the opioid prescriptions given at discharge after major urologic cancer surgery. Methods We reviewed opioid prescription data from patients discharged from our facility after major urologic cancer surgery from 2016 to 2018, including cystectomy, nephrectomy (total, partial) and prostatectomy. The opioid prescriptions were normalized to hydrocodone-5 mg tablet equivalents. Multivariable analysis was performed to evaluate the effect of various factors on opioid prescriptions at discharge. Results 409 patients met the inclusion criteria, with 207 without ERAS and 202 on ERAS protocol. Potent opioid (oxycodone or hydrocodone) use was reduced from 92% to 43% and tramadol use increased from 8% to 57% (p < 0.001). Following ERAS, we noted reduction in opioid prescriptions for prostatectomy (30%, p < 0.001), cystectomy (27%, p = 0.02) and all nephrectomy procedures (32%, p < 0.001). On multivariable analysis for each procedure, ERAS protocol was a significant predictor of opioid prescriptions at discharge. Conclusions A significant decrease in the opioid prescriptions given at discharge was noted after major urologic cancer surgery with the use of ERAS protocols. There was a significant shift towards the use of less potent opioids. These findings provides a benchmark for further interventions and reduction in the outpatient opioid prescriptions after major urologic surgery.