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A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge

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Abstract

Background

The evolving conceptualization of the management of surgical pain was a major contributor to the supply of narcotics that led to the opioid crisis. We designed and implemented a breast surgery-specific Enhanced Recovery After Surgery (ERAS) protocol using opioid-sparing techniques to eliminate narcotic prescription at discharge without sacrificing perioperative pain control.

Methods

A pilot observational study included patients with and without cancer undergoing lumpectomy. The convenience sample consisted of an ERAS group and a control usual care (UC) group who underwent surgery during the same time period. Discharge narcotic prescriptions were compared after converting to oral morphine milligram equivalents (MME’s). Postoperative day one and week one pain scores were also compared between the two groups.

Results

Ninety ERAS and 67 UC patients were enrolled. Most lumpectomies were wire-localized, and half of the patients in each group had breast cancer. There were more obese patients in the ERAS group. UC lumpectomy patients were discharged with a median of 54.5 MMEs (range 0–120), while the ERAS lumpectomy patients were discharged with none (p < 0.001). Postoperative pain scores were not significantly different between groups, and there were few complications.

Conclusion

A breast surgery-specific ERAS protocol employing opioid-sparing techniques successfully eliminated postoperative narcotic prescription without sacrificing perioperative pain control or increasing postoperative complications. By promoting the adoption of similar protocols, surgeons can continue to improve patient outcomes while decreasing the quantity of narcotics available for diversion within our patients’ communities.

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Acknowledgements

We would like to thank the Maimonides Medical Center Anesthesiologists and Perioperative Staff, General Surgery and Anesthesiology Residents, Pharmacy Staff, and the Staff of the Brooklyn Breast Center of Maimonides Medical Center. Special thanks to Johanna Yu BSN, RN, Mohamad Hashim MD, Nermin Ahmed-Yakop, Carin Zelkowitz PA-C, Jeffey Jacobs PA-C, Mary-Ann Myrthil PA-C, and Fara Maldonado whose cooperation and flexibility in implementing and promoting the ERAS protocol was not only beneficial to our study but to our patients.

Funding

This study did not receive funding.

Author information

Authors and Affiliations

  1. Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA

    Kristin E. Rojas, Donna-Marie Manasseh, Nicole Bilbro, Charusheela Andaz & Patrick I. Borgen

  2. Peter Flom Consulting, New York, NY, USA

    Peter L. Flom

  3. Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA

    Solomon Agbroko

Authors
  1. Kristin E. Rojas
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  2. Donna-Marie Manasseh
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  3. Peter L. Flom
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  4. Solomon Agbroko
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  5. Nicole Bilbro
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  6. Charusheela Andaz
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  7. Patrick I. Borgen
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Corresponding author

Correspondence to Kristin E. Rojas.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

The authors report no commercial interests relevant to the present work. There was no outside source of financial or material support for this study.

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Rojas, K.E., Manasseh, DM., Flom, P.L. et al. A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge. Breast Cancer Res Treat 171, 621–626 (2018). https://doi.org/10.1007/s10549-018-4859-y

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  • DOI: https://doi.org/10.1007/s10549-018-4859-y

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