Persistent Opioid and Benzodiazepine Use after Radical Cystectomy in Enhanced Recovery after Surgery (ERAS) Patients - Beyond the Abstract
We did not note any associations between preoperative opioid and benzodiazepine script volume and perioperative outcomes such as length of stay, return of bowel function, inpatient opioid utilization, complications, readmissions, or emergency department visits.
New persistent opioid use has become a popular outcome but in reality, it is a surrogate for the potential of misuse and diversion we associate with long term opioid use. The complicated nature of this outcome was highlighted by Jivraj showing that out of 39 studies, 29 will define it differently! (Jivraj) Persistent opioid use is difficult to uniformly define as one must consider the timing, volume, and frequency of opioid prescriptions post operatively. We feel therefore that this outcome functions best as a call to action.
We ultimately examined our preoperative opioid use and perioperative outcomes to enrich our prehabilitation program. Prehabilitation is another facet of the enhanced recovery process, focusing on modifying preoperative variables such as nutrition, mental health, and social determinants of health. We suspect that prospective intervention may be a means to decrease persistent opioid use and its associated harms. Another approach could be the creation of prospective pain plans prior to surgery. Several studies in orthopedic literature have described their positive effects on decreased opioid use. (Rozenfeld, Jameison) Our future work will investigate effective ways to measure actual opioid utilization after discharge to get a more realistic sense of what “persistent use” looks like. We hope our manuscript will serve as a call to action and prompt collaborative and creative ways to improve care and safety for our patients.
Written by: Samuel J. Ivan, MD, Hailey W. Holck, BS, & Stephen B. Riggs, MD, Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC.
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