Assess the effect of Enhanced Recovery After Surgery with and without liposomal bupivacaine (LB) on opioid use, hospital length of stay (LOS), costs, and morbidity of women undergoing sacrocolpopexy.
Retrospective cohort of women who underwent abdominal sacrocolpopexy between April 1, 2009, and November 30, 2017. Costs for relevant health care services were determined by assigning 2017 charges multiplied by 2017 Medicare Cost Report’s cost to charge ratios. Outcomes were compared among periods with multivariable regression models adjusted for age, ASA score, and concurrent hysterectomy and posterior repair.
Patients were subdivided into pre-ERAS ([G1], n=128), post-ERAS ([G2], n=83), and post-ERAS plus LB ([G3], n=91). The proportion of patients needing opioids during POD 0-2 was significantly less for G3 (75.8%) compared to G1 (97.7%) and G2 (92.8%); p<0.001). The median morphine equivalent units (MEU), mean LOS and adjusted mean standardized costs were significantly lower in G3 compared to the other two groups [(35 [20-75] vs 67 [31-109] and 60 [30-122] MEUs; 1.8 vs 2.3 vs 2.9 days; and $2,391, $2,975 and $3,844 dollars, for G3, G2, and G1, respectively p<0.001].
Implementation of Enhanced Recovery After Surgery pathway led to significant decreases in opioid use, LOS, and costs. Supplementation with LB further improves these measures.

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