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01-11-2020 | Mastectomy | Breast Oncology

Post-operative Nausea and Analgesia Following Total Mastectomy is Improved After Implementation of an Enhanced Recovery Protocol

Authors: Kate H. Dinh, MD, MS, Priscilla F. McAuliffe, MD, PhD, Michael Boisen, MD, Stephen A. Esper, MD, MBA, Kathirvel Subramaniam, MD, Jennifer G. Steiman, MD, Atilla Soran, MD, Ronald R. Johnson, MD, Jennifer M. Holder-Murray, MD, Emilia J. Diego, MD

Published in: Annals of Surgical Oncology | Issue 12/2020

Abstract

Background

Enhanced Recovery Protocols (ERPs) provide a multimodal approach to perioperative care, with the aims of improving patient outcomes while decreasing perioperative antiemetic and narcotic requirements. With high rates of post-operative nausea or vomiting (PONV) following total mastectomy (TM), we hypothesized that our institutional designed ERP would reduce PONV while improving pain control and decrease opioid use.

Methods

An ERP was implemented at a single institution for patients undergoing TM with or without implant-based reconstruction. Patients from the first two months of implementation (ERP group, N = 72) were compared with a retrospective usual-care cohort from a three-month period before implementation (UC group, N = 83). Outcomes included PONV incidence, measured with antiemetic use; patient-reported pain scores; perioperative opioid consumption, measured by oral morphine equivalents (OME); and length of stay (LOS).

Results

The characteristics of the two groups were similar. PONV incidence and perioperative opioid consumption were lower in the ERP than the UC group (21% vs. 40%, p 0.011 and mean 44.1 OME vs. 104.3 OME, p < 0.001), respectively. These differences in opioid consumption were observed in the operating room and post-anesthesia care unit (PACU); opioid consumption on the floor was similar between the two groups. Patient-reported pain scores were lower in the ERP than the UC group (mean highest pain score 6.4 vs. 7.4, p 0.003). PACU and hospital LOS were similar between the two groups.

Conclusion

ERP implementation was successful in decreasing PONV following TM with and without reconstruction, while simultaneously decreasing overall opioid consumption without compromising patient comfort.

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Title: Post-operative Nausea and Analgesia Following Total Mastectomy is Improved After Implementation of an Enhanced Recovery Protocol
Authors: Kate H. Dinh, MD, MS
Priscilla F. McAuliffe, MD, PhD
Michael Boisen, MD
Stephen A. Esper, MD, MBA
Kathirvel Subramaniam, MD
Jennifer G. Steiman, MD
Atilla Soran, MD
Ronald R. Johnson, MD
Jennifer M. Holder-Murray, MD
Emilia J. Diego, MD
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keywords: Mastectomy
Nausea
Opioids
Opioids
Postoperative Nausea and Vomiting
Published in: Annals of Surgical Oncology / Issue 12/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-020-08880-1

At a glance: The STEP trials

Springer Medicine

Post-operative Nausea and Analgesia Following Total Mastectomy is Improved After Implementation of an Enhanced Recovery Protocol

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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