Presentation Authors: Elliot Dubowitch*, Mohit Garg, Dimitre Stefanov, Buddima Ranasinghe, Piyush Gupta, David Silver, Ervin Teper, Ariel Schulman, Brooklyn, NY
Introduction: Postoperative narcotic-sparing strategies as part of an enhanced recovery after surgery (ERAS) protocol hasten return of bowel function and reduce narcotic use after surgery, limiting the potential for narcotic abuse. While analysis of ERAS protocols has focused upon postoperative narcotic reduction, the impact of intraoperative narcotic use is not well understood. We examined the impact of intraoperative narcotic use on extended length of stay (LOS) and 30-day readmission in a cohort of patients undergoing robotic urologic surgery.
Methods: We retrospectively reviewed patients who underwent robotic surgery of the kidney and prostate from 2016 to 2017. Patients were managed on an ERAS protocol with early ambulation, enteral feeding, and non-narcotic post-operative pain control. Stepwise linear regression was used to identify factors associated with increased intraoperative narcotic use. Stepwise logistic regression was used to determine predictors of LOS>1 and a logistic regression model was used to investigate predictors of 30-day readmission. P < 0.05 was considered statistically significant. SAS 9.4 (SAS Institute Inc., Cary NC) was used for the analyses.
Results: The study cohort included 194 patients. 104 (54%) patients had surgery on the upper tract and 90 had surgery on the lower tract. There were 41 (21%) females and the ages ranged from 23 to 80 years old with a mean (SD) of 59.5 (10.2) years. The mean (SD) for intraoperative morphine equivalents was 31.1 (9.2), with a range of 10-71.7. We used a stepwise linear regression to select from the following list of potential predictors of intraoperative narcotic use: age, gender, BMI, ASA>2, surgery type (upper vs. lower tract), surgeon, and operating time. Older age (beta=-0.21, 95% CI -0.33 to -0.08, p=0.001) and female gender (beta=-3.54, 95% CI -6.59 to -0.50, p=0.02) were associated with lower use of intraoperative narcotics. BMI (beta=0.33, 95% CI 0.07-0.60, p=0.01) was associated with higher usage of narcotics. For our cohort, 18 (9%) had a LOS>1 and 11 (6%) patients had a 30-day readmission. Upon logistic regression analysis, intraoperative narcotics was not associated with LOS>1 or 30-day readmission rates (OR=0.95, 95% CI 0.87-1.04, p=0.25).
Conclusions: Male gender, younger age, and higher BMI were associated with higher intraoperative narcotic use during robotic urologic surgery on an ERAS protocol, although increased intraoperative narcotics did not extend LOS or increase 30-day readmission rates.