PDF icon Download PDF
Am J Perinatol 2023; 40(09): 945-952
DOI: 10.1055/s-0041-1732450
Original Article

Implementation of an Enhanced Recovery after Surgery Pathway to Reduce Inpatient Opioid Consumption after Cesarean Delivery

Jared L. Tepper
1   Department of Obstetrics and Gynecology, Pennsylvania Hospital, Malvern, Pennsylvania
,
Olivia M. Harris
1   Department of Obstetrics and Gynecology, Pennsylvania Hospital, Malvern, Pennsylvania
,
Jourdan E. Triebwasser
1   Department of Obstetrics and Gynecology, Pennsylvania Hospital, Malvern, Pennsylvania
,
Stephanie H. Ewing
1   Department of Obstetrics and Gynecology, Pennsylvania Hospital, Malvern, Pennsylvania
,
Aasta D. Mehta
1   Department of Obstetrics and Gynecology, Pennsylvania Hospital, Malvern, Pennsylvania
,
Erica J. Delaney
1   Department of Obstetrics and Gynecology, Pennsylvania Hospital, Malvern, Pennsylvania
,
Harish M. Sehdev
1   Department of Obstetrics and Gynecology, Pennsylvania Hospital, Malvern, Pennsylvania
› Author Affiliations
Funding None.
› Further Information
Also available ateRefHebammen
   Permissions and Reprints
Preview

Abstract

Objective Opioid prescription after cesarean delivery is excessive and can lead to chronic opioid use disorder. We assessed the impact of an enhanced recovery after surgery (ERAS) pathway on inpatient opioid consumption after cesarean delivery.

Study Design An ERAS pathway was implemented as a quality improvement initiative in December 2019. Preintervention (PRE) data were collected from March to May 2019 to assess baseline opioid consumption. Postintervention (POST) data were collected from January to March 2020. The primary outcome was inpatient postoperative opioid consumption in morphine milligram equivalents (MME). Secondary outcomes included the consumption of any opioids, postpartum length of stay, and opioid prescription at discharge.

Results A total of 92 women were in the PRE group and 91 were in the POST group. Inpatient opioid consumption decreased by 87.3% from PRE to POST, from 124.7 (interquartile range [IQR]: 10–181.6) MME to 15.8 (IQR: 0–75) MME (p < 0.001). There was no difference in median postpartum length of stay (3.4 days PRE vs. 3.3 days POST; p = 0.12). The proportion of women who did not consume any opioids increased by 75.4% from PRE to POST (p = 0.02). The proportion of women discharged with an opioid prescription decreased by 25.6% from PRE to POST (p = 0.007), despite no formal change to prescribing practices. After adjustment for differences in race/ethnicity and gravidity, there was still a reduction in total inpatient opioid consumption (p < 0.001) and an increase in the proportion of women not consuming any opioids (adjusted relative risk (RR): 2.14, 95% confidence interval [CI]: 1.18–3.87), but the difference in rate of prescription of opioids at discharge was no longer statistically significant (adjusted RR: 0.70, 95% CI: 0.48–1.02).

Conclusion Adoption of an ERAS pathway for cesarean delivery resulted in a marked reduction in inpatient opioid consumption. Such a pathway can be implemented across institutions and may be a powerful tool in combating the opioid epidemic.

Key Points

  • ERAS after cesarean reduces inpatient opioid consumption.

  • ERAS after cesarean increases the proportion of women not consuming any opioids.

  • This pathway can be feasibly adopted elsewhere.

Keywords

opioid - cesarean - enhanced - recovery - enhanced recovery after surgery

Note

A.D.M. works part time for the Philadelphia Department of Health.


Authors' Contributions

J.L.T., O.M.H., S.H.E., A.D.M., and E.J.D. conceived the study question and assisted with implementation of the quality initiative. J.L.T., O.M.H., J.E.T., and H.M.S. helped to conceive the study design and interpreted the results. J.L.T. and O.M.H. performed data collection and J.E.T. performed data analysis. J.L.T., O.M.H, and J.E.T. drafted the manuscript. All authors made substantial contributions in critically revising the manuscript. All authors fulfilled all conditions required for authorship and approved this submission.




Publication History

Received: 10 November 2020

Accepted: 17 June 2021

Article published online:
26 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA