MP39-12 ENHANCED RECOVERY AFTER SURGERY PROTOCOL FOR URETEROSCOPY: A PROSPECTIVE COMPARATIVE STUDY EVALUATING A NO OPIOID VERSUS STANDARD PROTOCOL

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II (MP39)1 Apr 2019MP39-12 ENHANCED RECOVERY AFTER SURGERY PROTOCOL FOR URETEROSCOPY: A PROSPECTIVE COMPARATIVE STUDY EVALUATING A NO OPIOID VERSUS STANDARD PROTOCOL Chad Gridley*, Jennifer Robles, Joshua Calvert, Nicholas Kavoussi, Taylor Winkler, Jennifer Jayaram, Matthew Fosnot, Justin Liberman, Brian Allen, Matthew McEvoy, Duke Herrell, Ryan Hsi, and Nicole Miller Chad Gridley*Chad Gridley* More articles by this author , Jennifer RoblesJennifer Robles More articles by this author , Joshua CalvertJoshua Calvert More articles by this author , Nicholas KavoussiNicholas Kavoussi More articles by this author , Taylor WinklerTaylor Winkler More articles by this author , Jennifer JayaramJennifer Jayaram More articles by this author , Matthew FosnotMatthew Fosnot More articles by this author , Justin LibermanJustin Liberman More articles by this author , Brian AllenBrian Allen More articles by this author , Matthew McEvoyMatthew McEvoy More articles by this author , Duke HerrellDuke Herrell More articles by this author , Ryan HsiRyan Hsi More articles by this author , and Nicole MillerNicole Miller More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556063.45364.73AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Nephrolithiasis patients undergoing ureteroscopy are at risk for opioid dependence due to the nature of the disease, multiple provider encounters across an acute episode, and surgical and stent-related pain. The objective of this study was to evaluate an Enhanced Recovery After Surgery (ERAS) care pathway that provides standardization for the anesthetic care and post-operative management of patients undergoing ureteroscopy and stent placement with a goal towards minimizing opioid exposure. METHODS: Consecutive patients undergoing ureteroscopy and stent placement were identified leading up to and after implementation of the ERAS protocol. Urinary symptoms, pain, and PROMIS survey scores were obtained before surgery. The ERAS protocol included preoperative non-opioid premedication, minimal intraoperative and post-anesthesia opioids, and explicitly written non-opioid discharge medications. Patients were contacted at 48-72 hours and seven days postop to obtain follow up survey scores. Unanticipated phone calls, emergency room visits, and need for opioid refills were obtained. Collected data was compared between the two study populations. RESULTS: Among 53 patients enrolled (29 pre-intervention, 24 ERAS), mean age was 54.2 years and 57% were women. There was no difference in gender or age between the groups. On univariate and multivariable analyses, there were no significant differences between preoperative and postoperative survey results (Figure 1). The difference in morphine equivalent dosages was significant (p<0.001). There were no significant differences seen between pre- or post-ERAS groups for additional opioid requests, unexpected patient phone calls, or emergency room visits. CONCLUSIONS: Implementation of this ERAS protocol for patients undergoing ureteroscopy and ureteral stenting resulted in reduction to almost near-zero levels of opioid prescribing with fewer post-operative phone calls and no adverse effect on patient reported outcomes, emergency room visits, or opioid refills. Source of Funding: none Nashville, TN© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e549-e549 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chad Gridley* More articles by this author Jennifer Robles More articles by this author Joshua Calvert More articles by this author Nicholas Kavoussi More articles by this author Taylor Winkler More articles by this author Jennifer Jayaram More articles by this author Matthew Fosnot More articles by this author Justin Liberman More articles by this author Brian Allen More articles by this author Matthew McEvoy More articles by this author Duke Herrell More articles by this author Ryan Hsi More articles by this author Nicole Miller More articles by this author Expand All Advertisement PDF downloadLoading ...