Outcomes of ERAS in Gynecologic Surgery

黄建宏

Outcomesof ERAS in Gynecologic Surgery

Evidence hasshown that enhanced recovery speeds convalescence and reduces morbidity andcost while maintaining patient satisfaction and quality of life. ERAS has beenapplied in gynecologic surgery in patients with benign disorders. Recent studytested enhanced recovery pathway on hospital length of stay, morbidity, cost,and patient satisfaction for women undergoing major abdominal surgery for gynecologicmalignancies and vaginal reconstructive procedures for pelvic organ prolapse. Thestudy was conducted in the Division of Gynecologic Surgery, Mayo Clinic,Rochester, Minnesota.

Methods:

This was aretrospective cohort study. Enhanced recovery was instituted on June 20, 2011,

as aquality improvement practice change and was used for all inpatients. Enhancedrecovery patients were then compared with consecutive historic controls matchedone to one by procedure type.

A total of241 enhanced recovery cases (81 complex cytoreductive, 84 staging, and 76vaginal surgery cases) and 235 historic controls (78 complex cytoreductive, 80staging, and 77 vaginal cases) were included in the study.

Results:

Enhancedrecovery resulted in a 2-day reduction in the mean length of stay for thiscohort.

Women inthe case group received significantly less opioids. Patient-controlledanalgesia was infrequently required in the women in the case group comparedwith the historic controls

Within theenhanced recovery cohort, patients who received intrathecal anesthesia had asignificantly shorter length of stay than those who did not.

Thirty-dayrates of complications, readmission, mortality, and the severity ofcomplications did not differ between groups.

Patientsatisfaction was high in all studied aspects of perioperative care with 90–99%rating satisfaction as excellent or very good.

Satisfactionwith control of postoperative nausea and vomiting was rated as excellent orvery good in 87%.

Conclusions:

Implementationof enhanced recovery after surgery in gynecologic surgery resulted in significantimprovement of postoperative outcomes.

Reference:

Kalogera E, Bakkum-Gamez JN, Jankowski CJ,Trabuco E, Lovely JK, Dhanorker S, et al. Enhanced recovery in gynecologicsurgery. Obstet Gynecol. 2013;122:319-28

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