Enhanced recovery after robotic ventral hernia repair: factors associated with overnight stay in hospital

Abstract

Purpose Enhanced recovery after surgery (ERAS) protocols lead to reduced post-operative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal post-operative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify factors associated with overnight stay in hospital, as well as patient-reported pain levels in the immediate post-operative period. Methods This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first 3 post-operative days and pre- and 30-day post-operative hernia-related quality of life, using the EuraHS questionnaire. Results A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (robotic transabdominal retromuscular umbilical prosthetic hernia repair) (60.6%) followed by bilateral roboTAR (robotic transversus abdominis release) (19.3%). The mean horizontal fascial defect was 4.8 cm, and the mean duration of surgery was 141 min. In total, 78 (71.6%) patients were discharged on the day of surgery, and factors associated with overnight stay were increasing fascial defect area, longer duration of surgery, and transverse abdominis release. There was no association between post-operative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P < 0.001). Conclusion An ERAS protocol after RVHR was associated with a high rate of outpatient procedures with low patient-reported pain levels.

Enhanced Recovery Pathway After Laparoscopic Hernioplasty in Patients With Ventral Hernias: Is It Necessary to Apply?

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Outcomes of Robotic Transabdominal Retromuscular Repair: 3-Year Follow-up

“…Beyond drain monitoring, the overnight stay allowed for observation of pain, monitoring and adherence to established enhanced recovery protocols for diet and early ambulation which are crucial to patient outcomes. These ERAS principles have been previously described by Fayezizadeh et al [ 30 ] and in recent publications by Marckmann et al [ 31 ].…”

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“…Patients underwent hernia repair in the same time period and were discharged using same discharge criteria [13]. Patients were scheduled for type of repair (open/robotic) based on patient characteristics and the attending surgeons' preferences.…”