Residents and Fellows Research in Progress
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Enhanced Recovery After Surgery (ERAS) in cardiothoracic surgery (CTS) utilizes a multimodal perioperative care pathway that aims to optimize outcomes and improve overall patient experience, with a key component being implementation of a multimodal, opioid-sparing pain approach. Non-steroidal anti-inflammatory drugs (NSAIDs) have benefits of potentially limiting opioid exposure and improving pain scores but may be associated with a risk of serious cardiovascular thrombotic events and acute kidney injury (AKI), and therefore have not been uniformly incorporated into multimodal pain approaches in CTS.
Research Question or Hypothesis: Are NSAIDs safe and effective as part of a multimodal pain approach strategy in cardiothoracic surgery patients?
Study Design: Retrospective cohort using electronic health record data from an academic medical center between December 2022 – June 2023.
Methods: Patients who undergo a coronary artery bypass graft (CABG) procedure and receive the institutional multimodal pain approach order set, which contains scheduled acetaminophen, gabapentin, and lidocaine patches, will be evaluated. In addition, NSAIDs can be ordered at the discretion of the care team. Patients with a contraindication to NSAIDs or reasons for high opioid utilization, such as those intubated for longer than 24 hours, will be excluded. Patients who receive the multimodal pain approach order set with and without NSAIDs will be compared. In the NSAID group, patients will only be included if they receive at least two doses of intravenous ketorolac. The primary endpoint is change in daily Morphine Milligram Equivalents (MME) from postoperative day zero through four. Secondary endpoints will include postoperative bleeding, development of an AKI, and intensive care unit length of stay. Categorical and continuous data will be analyzed by chi-squared and Wilcoxon rank-sum tests; respectively, using SAS version 9.4, with a significance level of 0.05. Institutional review board approval was obtained.
Results: In progress.
Conclusion: In progress.
Presenting Author
Chelsea Barvian PharmDKaleida Health/Buffalo General Medical Center
Authors
Brian Kersten PharmD, BCPS, BCCCP
Buffalo General Medical Center
Maya Chilbert Pharm.D., BCCP
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Ashley Woodruff Pharm.D., BCPS
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Stephanie Seyse PharmD, BCPS, FASHP, CACP
Kaleida Health/Buffalo General Medical Center