Enhanced Recovery and Same-Day Discharge After Minimally Invasive Sacrocolpopexy

Evans, Sarah; McCarter, Maggie S. J.; Abimbola, Obafunbi; Myers, Erinn M.

doi:10.1097/spv.0000000000001043

Cited by 5 publications

(32 citation statements)

References 22 publications

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“…The benefits of ERAS are well documented in gynecologic surgery, though previously restricted to gynecologic oncology [13][14][15] and benign hysterectomy. 6,16 A recent body of evidence suggests significant benefits in urogynecologic patient populations; ERAS implementation was associated with three-fold increase in same day discharge among women undergoing robotic or laparoscopic sacrocolpopexy 17 and with decreased LOS in a heterogeneous population of women undergoing vaginal and abdominal repairs. 7 Unfortunately, as the above-mentioned studies evaluated distinct patient populations it is challenging to make meaningful comparisons.…”

Section: Discussionmentioning

confidence: 99%

Impact of enhanced recovery implementation in women undergoing abdominal sacrocolpopexy

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Tamhane

Weaver

et al. 2022

Intl J Gynecology & Obste

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Enhanced recovery after surgery (ERAS) programs are based on multidisciplinary collaboration and are designed to mitigate the surgical stress response and hasten convalescence. 1,2 ERAS implementation substantially reduces hospital length of stay (LOS), opioid use, and costs while maintaining stable readmission rates and pain scores. 3 Studies regarding ERAS have focused primarily on oncologic procedures in gynecologic and colorectal surgery. 4,5 Yet, variability continues between specific components of ERAS pathways across and within surgical specialties. Driver elements accounting for the heterogeneous impact of ERAS on perioperative outcomes in gynecologic surgery need to be determined, with most previously assessed protocols not including incisional infiltration with liposomal bupivacaine (LB).

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Section: Discussionmentioning

confidence: 99%

Impact of enhanced recovery implementation in women undergoing abdominal sacrocolpopexy

Trad

Tamhane

Weaver

et al. 2022

Intl J Gynecology & Obste

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“…A significantly shorter hospital stay was observed in ERAS patients compared with non-ERAS controls (1,153 patients: MD, −16.17 hours; 95% CI, −24.07 to −8.26 hours; P < 0.0001, data from 6 studies 16–21 ) (Fig. 2).…”

Section: Resultsmentioning

confidence: 92%

“…Overall complication rates were not different among the 2 groups (876 patients: RR, 1.28; 95% CI, 0.99-1.64; P = 0.06, data from 4 studies 17,18,20,21 ). Finally, neither postdischarge visits nor readmission rates were found different among ERAS and non-ERAS groups (524 patients: RR, 1.68; 95% CI, 0.91-3.08; P = 0.10, data from 3 studies 16,17,21 and 552 patients: RR, 2.22; 95% CI, 0.65-7.55; P = 0.20, data from 3 studies, [16][17][18] respectively). The significant heterogeneity among the included studies in the report of pain scores, patient satisfaction, quality of recovery scores, and hospital costs precluded meta-analysis of those parameters (Table 2).…”

Section: Secondary Outcomesmentioning

confidence: 87%

“…Six studies that reported outcomes of 1,153 women were finally included in the present review. [16][17][18][19][20][21] Among them, ERAS protocols were implemented in 553 women, whereas the remaining 600 received standard perioperative care. One article was a prospective cohort study, 20 1 was a retrospective analysis of prospectively collected data, 17 whereas the other 4 were retrospective observational cohort studies.…”

Section: Study Selectionmentioning

confidence: 99%

“…Thromboembolic prophylaxis [16][17][18][19][20][21] • Antithrombotic elastic pressure stockings and/or low-dose heparin during hospitalization Antimicrobial prophylaxis [16][17][18][19][20][21] • Antibiotics administration prior to skin incision and intraoperatively • No routine use of antibiotics postoperatively…”

Section: Perioperative and Intraoperative Interventionsmentioning

confidence: 99%

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

Zacharakis

Diakosavvas

Prodromidou

et al. 2022

UROGC

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Importance The implementation of Enhanced Recovery After Surgery (ERAS) protocols may optimize the clinical outcome of surgical patients, by reducing the length of hospital stay (LOS) and improving the quality of recovery. Objective This study aims to evaluate the impact of ERAS protocols in the intraoperative and postoperative course of patients undergoing pelvic floor reconstructive surgery. Methods A systematic search of PubMed/MEDLINE, Embase, and the Cochrane Library was conducted up to January 2022, using the Systematic Reviews and Meta-analyses guidelines. Search terms, such as ERAS, urogynecology, sacrocolpopexy were tailored to each database as necessary. Statistical analysis was performed using the RevMan 5.4 software. Confidence intervals (CI) were set at 95%. Mean difference and risk ratio were used in the analysis, and the results were calculated using the random effect model. Results Six studies that reported outcomes of 1,153 women were included. The ERAS protocols were implemented in 553 women, whereas the remaining 600 received standard perioperative care. A significantly shorter LOS (mean difference, −16.17 hours; 95% CI, −24.07 to −8.26 hours; P < 0.0001) and a higher proportion of patients discharged within 24 hours postoperatively was observed in ERAS patients compared with non-ERAS controls (risk ratio, 3.08; 95% CI, 2.00-4.75; P < 0.00001). Operative time, estimated blood loss, complications, and readmission rates did not differ between the 2 groups. Conclusions Our analysis showed that ERAS protocols have a favorable impact on the perioperative course of urogynecologic populations. More research is required to determine those key components of ERAS protocols, specifically applicable and more beneficial to women with pelvic floor disorders.

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Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

et al. 2023

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Background Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was to address the proper role of robotic pelvic floor reconstructive procedures using expert opinion. Methods We set up an international, multidisciplinary group of 26 experts to participate in a Delphi process on robotics as applied to pelvic floor reconstructive surgery. The group comprised urogynecologists, urologists, and colorectal surgeons with long-term experience in the performance of pelvic floor reconstructive procedures and with the use of the robot, who were identified primarily based on peer-reviewed publications. Two rounds of the Delphi process were conducted. The first included 63 statements pertaining to surgeons’ characteristics, general questions, indications, surgical technique, and future-oriented questions. A second round including 20 statements was used to reassess those statements where borderline agreement was obtained during the first round. The final step consisted of a face-to-face meeting with all participants to present and discuss the results of the analysis. Results The 26 experts agreed that robotics is a suitable indication for pelvic floor reconstructive surgery because of the significant technical advantages that it confers relative to standard laparoscopy. Experts considered these advantages particularly important for the execution of complex reconstructive procedures, although the benefits can be found also during less challenging cases. The experts considered the robot safe and effective for pelvic floor reconstruction and generally thought that the additional costs are offset by the increased surgical efficacy. Conclusion Robotics is a suitable choice for pelvic reconstruction, but this Delphi initiative calls for more research to objectively assess the specific settings where robotic surgery would provide the most benefit.

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Enhanced Recovery and Same-Day Discharge After Minimally Invasive Sacrocolpopexy

Cited by 5 publications

References 22 publications

Impact of enhanced recovery implementation in women undergoing abdominal sacrocolpopexy

Impact of enhanced recovery implementation in women undergoing abdominal sacrocolpopexy

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

Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

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