Implementation of an enhanced recovery after surgery (ERAS) protocol in a gynaecology department – the follow-up at 1 year

Abstract

Aim of the studyAn ERAS protocol provides the latest perioperative care principles, whose primary aim is to reduce complication rates, and therefore mortality. The aim of this study is to establish the progress of the ERAS pathway implementation in our gynaecology department.Material and methodsThis was a retrospective analysis of two sets of 100 consecutive medical records: patients treated before (PRE-ERAS) and after (ERAS) introduction of the ERAS protocol. All patients were comparable and all underwent major gynaecological surgery. Patients as well as medical and nursing staff were informed about the proposed preparation, surgical management and postoperative routine.Results and conclusionsPatients were given supper and drank water during the night. Laparoscopic surgery was used in 44% and spinal anaesthesia was given for open surgery in 43 study patients. Use of drains was reduced only by 23%, bowel preparation by 15%. Intravenous fluid administration was reduced by 22%. Use of postoperative morphine was minimised to 12 patients. Postoperative nausea was managed with the regular use of anti-emetics. Anti-coagulation was given to 80% of the study group. Difficulties in the introduction of the ERAS protocol were due to refusal by some patients to mobilise and eat early postoperatively. Patients in the ERAS programme group were discharged earlier.Further information about the ERAS protocol in the media would facilitate patients’ education among conservative society. In order to introduce new and innovative treatment methods, one has to take into account the cultural and ideological factors, especially when patient involvement is essential.

Improvement of Outcome by Implementation of Enhanced Recovery Pathway in Gynecologic/ Oncology Surgery

“…In the current study, early mobilization of patients was instructed where the mean time until first patient ambulation was 11.59 ± 1.11 hour in group A and 24.4 ± 1.3 hours in group B with a significant difference between the two groups. these results are in agreement was the results of Nikodemski et al (16) where they found that post-operative early mobilisation on the day of surgery was achieved in 45% of the study group patients. On the other hand, none of the control group patients mobilised on the day of the operation (p < 0.0001).…”

Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population

“…To empirical knowing, the incidence of complication after hepatectomy is high (15%–48%), and the LOS in hospital is long. [ 9 ] These problems can be solved by ERAS application. Thus, it is highly appreciated.…”

Factors that Lengthen Patient Hospitalizations Following Laparoscopic Hysterectomy

“…[2][3][4] Implementation of the Enhanced Recovery After Surgery (ERAS) protocol in gynecologic surgery has yielded significant reductions in length of hospitalization and associated costs. 2, [5][6][7][8][9][10] The new accepted standard among gynecologic surgeons is to allow for discharge in the same day or in less than 23 hours following laparoscopic hysterectomy. 6,11 However, nationwide implementation of ERAS protocols, including at our institution, have not been established, and the incidence and specific predictors of prolonged hospitalization at our institution are not known.…”

“…2, [5][6][7][8][9][10] The new accepted standard among gynecologic surgeons is to allow for discharge in the same day or in less than 23 hours following laparoscopic hysterectomy. 6,11 However, nationwide implementation of ERAS protocols, including at our institution, have not been established, and the incidence and specific predictors of prolonged hospitalization at our institution are not known. Though the causes for prolonged hospitalization are multifactorial, identifying potentially modifiable factors is an important step toward making change.…”