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Enhanced Recovery After Surgery Multi-Modality Pain Regimen Performs Similar to PRN Narcotics on Outcomes and Pain Control After Cardiac Surgery: A Quality Improvement Project
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  • David Blitzer,
  • Chad T. Blackshear,
  • Jameika Stuckey,
  • Leslie Kruse,
  • Lawrence L. Creswell,
  • Seth Lirette,
  • Hannah Copeland
David Blitzer
Columbia University Department of Surgery

Corresponding Author:[email protected]

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Chad T. Blackshear
Fulcrum – Jackson MS
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Jameika Stuckey
University of Mississippi Department of Pharmacy Practice
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Leslie Kruse
University of Mississippi Department of Pharmacy Practice
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Lawrence L. Creswell
University of Mississippi Medical Center Department of Surgery Division of Cardiac Surgery – Jackson Mississippi
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Seth Lirette
Fulcrum – Jackson MS
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Hannah Copeland
Lutheran Hospital
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Background: While enhanced recovery after surgery (ERAS) pathways have been successfully applied for cardiac surgery, there has been limited research directly comparing ERAS protocols to ad hoc narcotic use after surgery. We hypothesized that a standardized ERAS protocol would provide similar pain management and psycho-emotional outcomes while decreasing the use of opioids in the hospital and after discharge. Methods: As part of a 7-month quality improvement project, cardiac surgery patients on a fast tracked to extubate pathway were assigned PRN narcotic pain management for 3 months (n=49). After a 1-month ERAS protocol optimization period, a separate group of patients were given the ERAS protocol (n=34). Clinical outcomes were gathered, and participants completed a quality of recovery survey that allowed for the assessment of pain and symptom control at 4 time-points post-surgery. Results: Among 83 participants, 66% were male and the mean age was 53 years. There were no differences in patient characteristics between PRN and ERAS groups (all p>0.244). There were no differences between ERAS and PRN groups for surgery characteristics (all p>0.060), inpatient outcomes (all p>0.658), or after-discharge outcomes (all p>0.397). Furthermore, across all time-point comparisons, there were no supported differences in patient-reported outcome and pain control between the ERAS and PRN narcotic groups (all p>0.075). Conclusions: An ERAS protocol demonstrated similar patient outcomes and pain control to traditional opioid use for postoperative cardiac surgery patients. Further research is recommended to further confirm the results of this study.
24 Dec 2021Submitted to Journal of Cardiac Surgery
25 Dec 2021Submission Checks Completed
25 Dec 2021Assigned to Editor
25 Dec 2021Reviewer(s) Assigned
02 Jan 2022Review(s) Completed, Editorial Evaluation Pending
02 Jan 2022Editorial Decision: Revise Major
12 Jan 20221st Revision Received
13 Jan 2022Assigned to Editor
13 Jan 2022Submission Checks Completed
13 Jan 2022Reviewer(s) Assigned
30 Jan 2022Review(s) Completed, Editorial Evaluation Pending
30 Jan 2022Editorial Decision: Revise Major
08 Feb 20222nd Revision Received
09 Feb 2022Submission Checks Completed
09 Feb 2022Assigned to Editor
09 Feb 2022Reviewer(s) Assigned
24 Feb 2022Review(s) Completed, Editorial Evaluation Pending
24 Feb 2022Editorial Decision: Accept