Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology

Abstract

Importance Enhanced recovery programs (ERPs) are considered standard of care across a variety of surgical disciplines, but ERPs have not been widely adopted in gynecology. Objective To describe ERP principles and the role of ERPs in gynecology and gynecologic oncology. Evidence Acquisition Comprehensive literature search performed using MEDLINE, the Cochrane Collaboration Database, and PubMed. Results Meta-analyses of a substantial number of randomized-controlled trials have shown that implementation of ERP protocols is associated with decreased length of hospital stay, a decrease in rates of postoperative complication, decreased morbidity, and cost savings while preserving patient satisfaction and quality of life. Conclusions and Relevance High quality evidence exists for improved outcomes among patients in ERPs. ERPs save resources and costs across the health care system. As quality metrics and bundled payments increase in healthcare, ERPs will have increasing prominence.

Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

“…This was also observed in our study; women with ICR mobilised significantly earlier compared with women with DCR, with a difference in medians of 15 hours. Patients with ICR are forced to get out of bed to void, which is a positive side effect of this regimen because early mobilisation has been associated with quicker recovery and decreased morbidity . In theory, patients with an indwelling catheter in place could also start mobilising, but they often have no incentive to do so.…”

“…Patients with ICR are forced to get out of bed to void, which is a positive side effect of this regimen because early mobilisation has been associated with quicker recovery and decreased morbidity. 11 In theory, patients with an indwelling catheter in place could also start mobilising, but they often have no incentive to do so. Despite the faster mobilisation, ICR did not, in our study, result in earlier hospital discharge.…”

“…To fully benefit from the advantages of minimally invasive surgery, all postoperative complications and side effects leading to prolonged recovery should be minimised . As a result, an adequate catheter management can be valuable for patients and their recovery.…”

“…4,5 To fully benefit from the advantages of minimally invasive surgery, all postoperative complications and side effects leading to prolonged recovery should be minimised. 11 As a result, an adequate catheter management can be valuable for patients and their recovery. With this in mind, the aim of our study was to evaluate if immediate catheter removal (ICR) after LH was associated with similar outcomes compared with delayed catheter removal (DCR).…”

Enhanced recovery for gynaecological surgery: a review

“…The pace of adoption and development differs in different specialties. Studies of ERAS in gynaecological surgeries for both benign and malignant conditions have reported improvement in patient satisfaction, length of hospital stay, and cost, while no difference in morbidity, mortality, and readmission rates 55,56 . Quality and safety are key drivers for changes in clinical interventions and systems.…”