Late Breaking Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Enhanced Recovery After Surgery (ERAS
®) evidence-based principles have demonstrated substantial improvement in patient outcomes, however; prior studies have not examined how the effectiveness of ERAS
® interventions is influenced by confounding pharmacotherapy variables, which in turn affect composite outcomes. Addressing this gap is critical for refining ERAS
® pharmacotherapy recommendations to advance patient care.
Research Question or Hypothesis: What latent pharmacoprophylaxis variables predict perioperative outcomes?
Study Design: Secondary analysis of a multi-site randomized retrospective cohort study.
Methods: Using R, pharmacoprophylaxis data were modeled from an existing dataset of 476 adult elective colorectal surgery patients during 2021 at 10 US medical centers. Primary outcomes were absence of surgical site infection, venous thromboembolism, and postoperative nausea and vomiting, and Clavien-Dindo (CD) I-II complications. Secondary outcomes included no CD III-V complications, hospital length of stay = 3 days and no readmission at 7 or 30 days.
Results: Patients separated into two latent classes, those with better and poorer primary and secondary outcomes. Pharmacotherapy variables predicting better primary and secondary composite outcomes (p<0.05) included scopolamine patch, neostigmine reversal, and intravenous (IV) fluid stop on postoperative day 1 or 2. Variables associated with worse primary and secondary composite outcomes included preoperative iron, aprepitant, gabapentin, and propofol. Postoperative morphine milligram equivalents (MME) < 50 was the only variable with a significant positive association for primary outcomes and a negative association for secondary outcomes. Those with opposite effect on outcomes included preoperative oral antibiotics, ondansetron, and ketamine non-anesthesia bolus. Patients without SSI or VTE had better overall outcomes.
Conclusion: Separating patients into subpopulations and identifying latent class variables predicted postoperative colorectal surgery outcomes. Preoperative oral antibiotics, postoperative MME < 50, ondansetron, and ketamine bolus use led to mixed outcomes. Scopolamine patch, neostigmine, and early IV fluid should be considered for all patients. Additional research on preoperative iron, aprepitant, gabapentin, and propofol for the timing of administration is needed.
Presenting Author
Edson Jean Jacques MSMercer University School of Medicine
Authors
Richard H.Parrish II BSPharm, MSc, PhD, FCCP, BCPS
Mercer University School of Medicine
John Roberts B.S.
Mercer University School of Medicine
Camron Sohn B.S.
Mercer University School of Medicine