Abstract
Background
Enhanced recovery after surgery (ERAS) pathways have improved surgical outcomes and
reduced narcotic needs. This study evaluated racial differences in our institution's
opioid prescribing practices in autologous breast reconstruction before and after
ERAS implementation.
Methods
This was a retrospective review of consecutive patients undergoing autologous breast
reconstruction from 2013 to 2021, pre-ERAS and after ERAS implementation. Primary
outcomes were morphine milligram equivalents (MME) for intravenous (IV) and oral (PO)
narcotics peri- and postoperatively. Secondary outcomes included infection, delayed
wound healing, and need for reoperation.
Results
Of 163 patients, 150 met inclusion criteria. The pre-ERAS group comprised 65 patients
(35% Black, 65% White), and the ERAS group included 85 patients (44% Black, 54% White).
Pre-ERAS, Black patients received more IV narcotics than White patients, 814 versus
505 MME (p < 0.05). There was no difference between inpatient and outpatient PO MME (p > 0.05). ERAS decreased IV MME 10-fold (p < 0.05) and decreased inpatient PO MME approximately 3-fold (p < 0.05). Nevertheless, racial differences existed in IV narcotics (80 vs. 58 MME;
p
<0.05) and inpatient PO narcotics (93 vs. 59 MME; p < 0.05). Black race was a significant positive predictor in univariate and multivariate
analyses for IV MME in both pre-ERAS and ERAS.
Conclusion
Black patients unexpectedly received more IV narcotics pre-ERAS. Although ERAS decreased
inpatient opioid administration, racial differences persisted; Black patients also
received more PO narcotics, contrary to literature findings of systemic pain undertreatment.
Standardized protocols alone may be inadequate to address complexities of postoperative
pain.
Keywords
breast reconstruction - opiates - racial inequalities
