Journal
SURGERY
Volume 169, Issue 1, Pages 197-201Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.surg.2020.04.065
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This study showed that the enhanced recovery protocol specific for thyroid/parathyroid surgery significantly reduced perioperative opioid use and decreased the occurrence of postoperative nausea and vomiting. Patients who used the enhanced recovery protocol had a much higher rate of being entirely opioid-free after surgery.
Background: Enhanced recovery protocols have not been investigated previously for cervical endocrine surgery. The study aim was to determine whether systematic implementation of an enhanced recovery protocol specific for thyroid/parathyroid surgery can improve postoperative outcomes. Methods: A customized enhanced recovery protocol for thyroid/parathyroid surgery was designed and utilized systematically for all patients who underwent parathyroidectomy, thyroid lobectomy, or total thyroidectomy. Outcomes were assessed 12 months before enhanced recovery protocol implementation (n = 464 patients) and after enhanced recovery protocol implementation (n = 654 patients). Results: Enhanced recovery protocol implementation was associated with a 72% decrease in mean oral morphine equivalents utilized in-house (before 82 +/- 64 versus after 23 +/- 28; P < .0001) and many enhanced recovery protocol patients were entirely opioid-free (0.2% vs 21%, P < .0001). When used, the enhanced recovery protocol was associated with a lesser mean amount of ondansetron to treat postoperative nausea and vomiting (5.5 mg +/- 3 vs 4.5 +/- 2: P < .0001). Duration of stay was short before implementation of the enhanced recovery protocol and did not change substantially after implementation (1.1 days +/- 0.7 vs 1.1 +/- 0.7; P = .26). Conclusion: The systematic use of a simple, cervical, endocrine surgery-specific enhanced recovery protocol decreased perioperative opioid use by similar to 70%, with significantly less postoperative nausea and vomiting. Implementation of a multidisciplinary enhanced recovery protocol may be an important initial step toward limiting opioid overuse during common operative procedures. (C) 2020 Elsevier Inc. All rights reserved.
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