Deborah S Keller, MS, MD1,2, Manish Chand, MBA, FRCS, PhD2. 1Columbia University Medical Center, 2University College London Hospitals, NHS Foundation Trusts
Background: Opioids are a mainstay for postsurgical pain management, but have significant associated complications, costs, and contribute to the spiraling opioid epidemic. Enhanced Recovery After Surgery (ERAS) protocols aim to reduce opioid utilization and improve recovery, with laparoscopy pivotal in this effort. Little study has been done on opioid utilization and its impact across surgical approaches. Our goal was to evaluate the impact of opioid utilization across quality measures and costs after open and laparoscopic colorectal surgery.
Methods: The Premier Database was reviewed for inpatient colorectal procedures from 1/1/2014-9/30/2015. Procedures were stratified into open (OPEN) and laparoscopic (LAP) approaches, then separated into “Opioid” and “Opioid-free” groups within each approach. Univariate analysis compared demographics, quality outcomes, and cost by opioid use and approach. Multivariable regression analysis examined the association between opioid use, costs, and clinical outcomes, controlling for approach, demographics, payers and hospital characteristics.
Results: 50,098 procedures were evaluated- 40.4% were LAP and 59.6% OPEN. 2.3% of LAP and 4.8% of OPEN reported pre-existing chronic pain. 6.6% of LAP and 5.3%, of OPEN were “opioid-free”. Length of stay was significantly shorter and total costs significantly lower in the opioid-free group in both approaches (all p<0.001). Mortality was significantly lower in the opioid-free group for LAP (p<0.001). From the regression model, opioid use was more common in patients aged 18-64 than the elderly, emergency cases, those with pre-existing chronic pain, non-teaching hospitals, commercial insurance, and an open approach (all p<0.05). With opioid use, the likelihood of readmissions was increased by 14% and total hospital costs were increased by 16%. Compared to LAP, OPEN were 1.2 times more likely to use opioids, 1.4 times more likely to have postoperative complications, and 1.4 times more likely to be readmitted. When comparing across approaches overall, LAP further improved quality outcomes and cost over OPEN in all measures.
Conclusions: Opioid-free colectomy can be a reality, and results in significantly improved healthcare utilization and postoperative outcomes in both laparoscopic and open colorectal surgery. Laparoscopy further improves outcomes over open surgery, with improved quality measures and lower overall costs for the surgical episode. These results highlight the benefit of continued efforts to reduce opioid utilization, improve patient outcomes, and expand utilization of laparoscopy. These initiatives that add value and lower costs will be critical during the transition to value-based payments.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86235
Program Number: S125
Presentation Session: ERAS Session
Presentation Type: Podium