Background

Enhanced Recovery Programs (ERPs) have been introduced in many surgical specialties with improved perioperative outcomes. Multimodal, opioid-sparing analgesia and preoperative nerve blocks are key tenets of ERPs that promote better postoperative pain control. This study aimed to examine the impact of bariatric surgery ERP implementation on opioid utilization at a single institution.

Methods

A retrospective cohort study was conducted among patients undergoing minimally invasive bariatric surgery at a single institution January 2017- May 2022. After bariatric ERP implementation in January 2020, the cohort was divided into pre-ERP (2017- 2019) and post-ERP (2020- 2022) groups. The primary outcome was opioid administration, calculated by oral morphine equivalents (OMEs), compared between the pre- and post-ERP groups. ERP adherence was also assessed in the post-ERP group.

Results

770 patients were identified, including 366 pre-ERP and 404 post-ERP patients. Groups were similar in age, preoperative BMI, and sex (Table 1). Postoperative opioid use was lower after ERP implementation, with significantly fewer daily OMEs in the post-ERP cohort (35.0 [19.3-55.5] OMEs/day pre-ERP vs 17.5 [9.0-36.0] OMEs/day post-ERP, p<0.001). There were fewer OMEs per admission post-ERP (61.5 [30.0-101.8] pre-ERP vs 25.0 [12.0-50.0] post-ERP, p<0.001) (Figure 1). Adherence was high for many ERP components (Figure 1), including postoperative multimodal analgesia (88.4%) and preoperative block administration (85.6%).

Conclusions

Implementation of a bariatric surgery ERP was associated with significantly reduced daily and total opioid use during the hospital admission. Increased adherence with certain ERP components, such as preoperative block administration and multimodal analgesia, may further improve perioperative pain control.