The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery
© 2022. The Author(s)..
OBJECTIVE: The Enhanced Recovery after Surgery Cardiac Society recommends using multimodal analgesia (MMA) for postoperative pain however, evidence-based guidelines have yet to be established. This study examines the impact of a standardized postoperative MMA pathway in reducing opioid consumption and related complications after cardiothoracic surgery (CTS).
METHODS: Within a multicenter healthcare system, a postoperative MMA pathway was developed and implemented at two CTS intensive care units (ICU) while the other CTS ICU opted to maintain the existing opioid-based pathway. A retrospective chart review was conducted on patients admitted to a CTS ICU within this healthcare system after conventional coronary artery bypass grafting and/or valve surgery from September 1, 2018, to June 30, 2019. Comparative analysis was conducted on patients prescribed MMA versus those managed with an opioid-based pathway. The primary outcome was total opioid consumption, converted to morphine milligram equivalents, 72-h post-surgery. Secondary outcomes included mobility within one-day post-surgery, ICU length of stay (LOS), time to first bowel movement (BM), and time to first zero Richmond Agitation-Sedation Scale (RASS).
RESULTS: Seven hundred sixty-two adults were included for final analysis. The MMA group had a higher body mass index, higher percentage of females, were more likely classified as African American and had higher scores for risk-adjusted complications. General Linear Model analysis revealed higher opioid consumption in the MMA group (Est. 0.22, p < 0.0009); however, this was not statistically significant after adjusting for differences in fentanyl usage. The MMA group was more likely to have mobility within one-day post-surgery (OR 0.44, p < 0.0001), have longer time to first BM (OR 1.93, p = 0.0011), and longer time to first zero RASS (OR 1.62, p = 0.0071). The analgesia groups were not a predictor for ICU LOS.
CONCLUSIONS: Opioid consumption was not reduced secondary to this postoperative MMA pathway. The MMA group was more likely to have mobility within one-day post-surgery. Patients in the MMA group were also more likely to have prolonged time to first BM and first zero RASS. Development and evaluation of a perioperative MMA pathway should be considered.
| Errataetall: |
ErratumIn: J Cardiothorac Surg. 2023 Jan 23;18(1):45. - PMID 36691094 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
Journal of cardiothoracic surgery - 17(2022), 1 vom: 30. Dez., Seite 342 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ward, Ceressa T [VerfasserIn] |
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| Links: |
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| Themen: |
Analgesics, Opioid |
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| Anmerkungen: |
Date Completed 02.01.2023 Date Revised 23.01.2023 published: Electronic ErratumIn: J Cardiothorac Surg. 2023 Jan 23;18(1):45. - PMID 36691094 Citation Status MEDLINE |
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| doi: |
10.1186/s13019-022-02067-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM350932867 |
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| 100 | 1 | |a Ward, Ceressa T |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery |
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| 500 | |a published: Electronic | ||
| 500 | |a ErratumIn: J Cardiothorac Surg. 2023 Jan 23;18(1):45. - PMID 36691094 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. The Author(s). | ||
| 520 | |a OBJECTIVE: The Enhanced Recovery after Surgery Cardiac Society recommends using multimodal analgesia (MMA) for postoperative pain however, evidence-based guidelines have yet to be established. This study examines the impact of a standardized postoperative MMA pathway in reducing opioid consumption and related complications after cardiothoracic surgery (CTS) | ||
| 520 | |a METHODS: Within a multicenter healthcare system, a postoperative MMA pathway was developed and implemented at two CTS intensive care units (ICU) while the other CTS ICU opted to maintain the existing opioid-based pathway. A retrospective chart review was conducted on patients admitted to a CTS ICU within this healthcare system after conventional coronary artery bypass grafting and/or valve surgery from September 1, 2018, to June 30, 2019. Comparative analysis was conducted on patients prescribed MMA versus those managed with an opioid-based pathway. The primary outcome was total opioid consumption, converted to morphine milligram equivalents, 72-h post-surgery. Secondary outcomes included mobility within one-day post-surgery, ICU length of stay (LOS), time to first bowel movement (BM), and time to first zero Richmond Agitation-Sedation Scale (RASS) | ||
| 520 | |a RESULTS: Seven hundred sixty-two adults were included for final analysis. The MMA group had a higher body mass index, higher percentage of females, were more likely classified as African American and had higher scores for risk-adjusted complications. General Linear Model analysis revealed higher opioid consumption in the MMA group (Est. 0.22, p < 0.0009); however, this was not statistically significant after adjusting for differences in fentanyl usage. The MMA group was more likely to have mobility within one-day post-surgery (OR 0.44, p < 0.0001), have longer time to first BM (OR 1.93, p = 0.0011), and longer time to first zero RASS (OR 1.62, p = 0.0071). The analgesia groups were not a predictor for ICU LOS | ||
| 520 | |a CONCLUSIONS: Opioid consumption was not reduced secondary to this postoperative MMA pathway. The MMA group was more likely to have mobility within one-day post-surgery. Patients in the MMA group were also more likely to have prolonged time to first BM and first zero RASS. Development and evaluation of a perioperative MMA pathway should be considered | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiac surgery | |
| 650 | 4 | |a Enhanced recovery after cardiac surgery | |
| 650 | 4 | |a Multimodal analgesia (MMA) | |
| 650 | 4 | |a Opioid | |
| 650 | 4 | |a Postoperative analgesia | |
| 650 | 7 | |a Analgesics, Opioid |2 NLM | |
| 700 | 1 | |a Moll, Vanessa |e verfasserin |4 aut | |
| 700 | 1 | |a Boorman, David W |e verfasserin |4 aut | |
| 700 | 1 | |a Ooroth, Lijo |e verfasserin |4 aut | |
| 700 | 1 | |a Groff, Robert F |e verfasserin |4 aut | |
| 700 | 1 | |a Gillingham, Trent D |e verfasserin |4 aut | |
| 700 | 1 | |a Pyronneau, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Prabhakar, Amit |e verfasserin |4 aut | |
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