P. K. Patel1, R. K. Burton1, K. E. Hudak1, L. E. Goss1, E. A. Dasinger1, M. Morris1, J. Richman1, G. Kennedy1, J. A. Cannon1, D. I. Chu1 1University Of Alabama at Birmingham,Gastrointestinal Division,Birmingham, Alabama, USA
Introduction: Racial disparities exist in surgical outcomes. Enhanced Recovery After Surgery (ERAS) protocols lead to improved outcomes and may reduce disparities. It is unclear, however, what the effect of ERAS is on post-discharge opioid utilization and whether racial disparities exist in opioid-specific outcomes. We hypothesized that there would be variations in opioid use between racial/ethnic groups with black patients prescribed more opioids and that this disparity would be reduced with ERAS.
Methods: This was a single institution study of patients undergoing ERAS for colorectal surgery in 2015, matched by race, age, sex, and procedure to a pre-ERAS group from 2010 to 2014. Patient, procedure, and opioid use characteristics were included. Each prescribed opioid was converted into standardized Oral Morphine Equivalents (OMEs). The primary outcome was the prescribed OMEs on discharge, OMEs over 1-year, and OME’s per pill (OME/P). Univariate and bivariate comparisons were performed using Chi-square and t-tests as appropriate. A p-value of less than 0.05 determined significance.
Results: Of the 395 patients (198 ERAS and 197 pre-ERAS) included, 28.3% were black. In the pre-ERAS group, a similar proportion of black and white patients were discharged with an opioid prescription (92.7% vs 92.3%, p=0.92). Within 1 year after surgery, opioid use decreased for both black and white patients (50.9% vs 49.3%, p=0.84). In the ERAS group, fewer patients were discharged with an opioid prescription but no difference was seen by race (89.3% for blacks, 85.9% for whites, p=0.53). Both black and white ERAS patients decreased opioid usage within 1 year (42.8% vs. 50.7%, p=0.32). At discharge, there was no difference in the OME/P between white and black patients under pre-ERAS (7.6 vs. 7.5, p=0.86) or ERAS (7.0 vs. 6.6, p=0.41) pathways. ERAS patients, however, did have significantly lower overall OME/P compared to pre-ERAS patients (p<.01). No differences in OME/P between racial groups were observed at 1-year post-discharge.
Conclusion: No racial disparities were observed in post-discharge opioid utilization in either the pre-ERAS or ERAS cohorts. ERAS did reduce overall opioid use, and possibly more for blacks than whites. However, a larger cohort is needed to confirm this hypothesis.
