Objective: The opioid crisis is partly due to opioids prescribed after elective surgery. We sought to determine if a preemptive pain-management program would be associated with opioid-free discharge after benign foregut surgery. Methods: A retrospective case-control study of prospectively collected data was conducted at a single institution of patients who underwent elective minimally invasive benign foregut surgery. We compared the outcomes among patients who were managed with standard care (control), enhanced recovery after surgery alone, or a preemptive pain-management program with enhanced recovery after surgery. Results: Among 414 patients, there were significantly fewer opioid medication prescriptions at discharge (9.6% vs 85.2% vs 87%, P < .001) and fewer postoperative complications (3.2% vs 14.8% vs 15.1%, P = .004) in the preemptive pain-management group (n = 94), enhanced recovery after surgery alone (n = 81), and the control group (n = 239), respectively. Multivariable logistic regression analysis showed that the preemptive pain-management program was a factor associated with a decrease in opioid medication prescriptions at discharge (odds ratio, 0.01; 95% confidence interval, 0.01-0.03; P < .001), as well as a decrease in complications after surgery (odds ratio, 0.22; 95% confidence interval, 0.06-0.79; P = .02). Moreover, in the preemptive pain-management group, average self-reported pain level in a subset of patients at 30 days after surgery was 0.9 ± 1.4 on a 0- to 10-point pain scale. Conclusions: The preemptive pain-management program was associated with opioid-free discharge after minimally invasive foregut surgery. This study provides a strategy to reduce opioid prescriptions after foregut surgery and, if implemented nationally, could decrease the amount of opioids used in the community.

Original languageEnglish (US)
Pages (from-to)734-744.e4
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number2
StatePublished - Feb 2020


  • enhanced recovery after surgery
  • foregut surgery
  • hiatal hernia
  • minimally invasive surgery
  • opioids
  • preemptive pain control

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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