The impact of enhanced recovery on opioid intake after colorectal and small bowel surgery

In March 2020, Medisch Spectrum Twente (MST) implemented the Enhanced Recovery After Surgery (ERAS) protocol to enhance recovery in patients undergoing colorectal and/or small bowel surgery. This retrospective cohort study compares the impact of ERAS on daily in-hospital opioid use for four postoperative days to Pre-ERAS practices. Primary outcomes revealed that the ERAS group had significantly lower odds of receiving opioids on days one, two, and three compared to Pre-ERAS, with adjusted odds ratios ranging from 0.18 to 0.28. Short-acting oxycodone emerged as the predominant postoperative opioid. ERAS protocol adherence was high on day zero (99.4%) but declined on subsequent days (41.8% to 78.8%). Patients with zero oxycodone intake (36.2%) demonstrated favorable outcomes, including a shorter length of stay (median: 2 days), lower VAS pain scores on days zero and one, and a quicker time until defecation compared to the High intake group (median: 5.5 days). Overall, the ERAS protocol positively impacted opioid use on postoperative days one to three, with short-acting oxycodone being the primary opioid administered. Patients with zero oxycodone intake experienced better outcomes, emphasizing the potential benefits of reduced opioid use in this surgical context.