Compliance and outcomes after implementation of an enhanced recovery surgical protocol in older women undergoing pelvic reconstructive surgery

Abstract

The aim of this study is to evaluate compliance and outcomes with implementation of an enhanced recovery surgical protocol in older women undergoing pelvic reconstructive surgery. This is a retrospective cohort study of women undergoing pelvic reconstructive surgery after implementation of the pathway over a 12-month period. Overall compliance was defined as a categorial variable requiring adherence to all of the selected bundle components in patients <65 years old compared to those ≥65. Intraoperative and 30-day postoperative complications were also compared and were reviewed by organ system, these were categorized using the Clavien-Dindo Classification system. There was no significant difference in overall compliance in patients <65 compared to ≥65. Factors that increased compliance in patients ≥65 include laparotomy, hysterectomy, hyperlipidaemia, time after implementation of the protocol and primary surgeon. There was an increase in compliance from 19% to 77% over the 12-month study period. Intra and postoperative complications were similar between the two groups. Enhanced recovery in older patients undergoing pelvic reconstructive surgery is feasible with similar rates of compliance and complications compared to younger patients. Compliance with the protocol increases as time after implementation of the protocol increases in all patients.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

“…In one such study, data were collected for the full year preceding implementation 123 . Another study specific to urogynecological patients showed increased compliance after implementation from 19% to 77% over the 12-month study period 121 . This is consistent with other studies in gynecological literature 124 .…”

“…These results may also be generalizable in urogynecology. After implementation, regular perioperative team meetings may be held to review compliance and audit outcomes to improve or modify portions of the ERAS protocol as needed 121 …”

“…After implementation, regular perioperative team meetings may be held to review compliance and audit outcomes to improve or modify portions of the ERAS protocol as needed. 121 Organizations may use existing strategic platforms for implementation or use a strategy that tailors the efforts to the specific needs at an institution and consider local barriers to change. 122 Urogynecology-specific ERAS protocols are often adopted from existing institutional protocols, and team members included should be those who have experience with such protocols.…”

“…4 Many studies use prospectively maintained databases collected through the electronic health record to track the progress and outcomes of ERAS implementation. 120,121 In one such study, data were collected for the full year preceding implementation. 123 Another study specific to urogynecological patients showed increased compliance after implementation from 19% to 77% over the 12-month study period.…”

Enhanced Recovery Protocols in Urogynecologic and Pelvic Floor Reconstructive Surgery: A Systematic Review and Meta-Analysis

“…After removal of duplicates, 493 articles were screened. Among them, 477 were excluded based on their title and/or abstract, thus, 16 articles were retrieved as full-texts 16–31 …”