Enhanced Recovery After Surgery (ERAS) Protocol on Urogynecological Surgeries: 3 years of follow-up after implementation

Abstract

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol for perioperative care recommends positive interventions to accelerate postoperative recovery, such as preoperative fasting abbreviation and prevention of thrombosis. Although applied in other surgical areas, data on its recommendations in urogynecological surgeries are scarce. The aim of this study was to evaluate the plausibility, reproducibility and impact of implementation of the main ERAS recommendations (preoperative fasting abbreviation and prevention of thrombosis) on urogynecological surgeries, in medical practice. Methods. After approval by ethics committee and signature of the free and informed consent form by the patients, a purely observational study was carried out under abbreviation for preoperative fasting with 400 ml of clear liquid enriched with carbohydrate and protein 4 hours and thromboprophylaxis approaches in urogynecological surgeries, from 2015 to 2019 in a medium complexity hospital, with analysis of parameters such as thrombotic events, length of stay and patient satisfaction on recovery after surgery. Results.Of 280 elective surgeries with abbreviation for preoperative fasting, the most frequent urogynecological procedures were: 85 (24.42%) posterior colpoplasties, 67 (19.25%) minor labioplasties and 36 (10.34%) midurethral slings. For venous tromboembolism prophylaxis subcutaneous enoxaparina (0,5mg/Kg) was used in 170 (60.07%) patients at moderate risk for thrombosis and mechanical measures for those at low risk, without thromboembolic complications. Mean hospitalization time was of one day. Conclusions. According to this study, abbreviation of preoperative fasting as described and thromboprophylaxis from ERAS recommendations were plausible, reproducible in medical practice and can be stimulated in urogynecological surgeries to accelerate the postoperative recovery.