Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery

Keil, Dayley S.; Schiff, Lauren; Carey, Erin T.; Moulder, Janelle K.; Goetzinger, Amy M.; Patidar, Seema M.; Hance, Lyla; Kolarczyk, Lavinia; Isaak, Robert S.; Strassle, Paula D.; Schoenherr, Jay

doi:10.1213/ane.0000000000003339

Cited by 56 publications

(54 citation statements)

References 34 publications

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“…16 Same-day discharge after laparoscopic and robotic hysterectomy has been described in many studies, the rates being between 27%-90%. 9,11,[17][18][19] In the study by Keil et al, 11 the length of hospital stay decreased from 34 hours to 20 hours. Minig et al 19 reported a median length of hospital stay of 22.7 hours.…”

Section: Discussionmentioning

confidence: 94%

Recovery after enhanced versus conventional care laparoscopic hysterectomy performed in the afternoon: A randomized controlled trial

Kilpio

Härkki

Mentula

et al. 2020

Intl J Gynecology & Obste

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Objective: To compare enhanced recovery after surgery (ERAS) and conventional care (CC) protocols on outcomes of laparoscopic hysterectomy (LH) performed in the afternoon. Methods: A single-center randomized controlled trial was conducted on 120 women undergoing LH who were randomly divided into the intervention group (IG; n=60) and control group (CG; n=60). Women in the IG were treated according to the ERAS protocol and those in the CG according to the CC protocol. The primary outcome was the length of hospitalization. Secondary outcomes were postoperative opioid use, postoperative pain and emesis, complications, operative bleeding, and time. Results: More women discharged during 24 hours in the IG than in the CG (88% vs 55%, P<0.001). The time to actual discharge (19 vs 22 hours, P<0.001) and ready-todischarge time (15 vs 21 hours, P<0.001) were shorter and the use of oxycodone was lower (0 mg [0-0 vs 2.5 mg [0-10], P<0.001) in the IG than in the CG, respectively. Otherwise, no other significant differences between the groups were observed. The follow-up time was one month. Conclusion: The ERAS protocol reduces hospital stay and decreases the use of opioids with no impairment in surgical outcome of LH.

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Section: Discussionmentioning

confidence: 94%

Recovery after enhanced versus conventional care laparoscopic hysterectomy performed in the afternoon: A randomized controlled trial

Kilpio

Härkki

Mentula

et al. 2020

Intl J Gynecology & Obste

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“…ERAS has been of considerable interest to the field of medicine in recent years [2]. ERAS protocols were first applied in colorectal surgery [2], expanding gradually to obstetrics and gynaecology [3], urology [4], and pelvic surgery [5]. Multimodal perioperative care played a vital role in the ERAS protocols that were based on ERAS society guidelines [6].…”

Section: Introductionmentioning

confidence: 99%

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

et al. 2020

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Background: Although enhanced recovery after surgery (ERAS) has made great progress in the field of surgery, the guidelines point to the lack of high-quality evidence in upper gastrointestinal surgery. Methods: Randomized controlled trials in four electronic databases that involved ERAS protocols for upper gastrointestinal surgery were searched through December 12, 2018. The primary endpoints were lung infection, urinary tract infection, surgical site infection, postoperative anastomotic leakage and ileus. The secondary endpoints were postoperative length of stay, the time from end of surgery to first flatus and defecation, and readmission rates. Subgroup analysis was performed based on the type of surgery. Results: A total of 17 studies were included. The results of the meta-analysis indicate that there was a decrease in rates of lung infection (RR = 0.50, 95%CI: 0.33 to 0.75), postoperative length of stay (MD =-2.53, 95%CI: − 3.42 to − 1.65), time until first postoperative flatus (MD =-0.64, 95%CI: − 0.84 to − 0.45) and time until first postoperative defecation (MD =-1.10, 95%CI: − 1.74 to − 0.47) in patients who received ERAS, compared to conventional care. However, other outcomes were not significant difference. There was no significant difference between ERAS and conventional care in rates of urinary tract infection (P = 0.10), surgical site infection (P = 0.42), postoperative anastomotic leakage (P = 0.45), readmissions (P = 0.31) and ileus (P = 0.25). Conclusions: ERAS protocols can reduce the risk of postoperative lung infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed undergoing gastrectomy and esophagectomy.

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“…Initially proposed by Danish surgeon, Henrik Kehle, ERAS is a multi-professional and multidisciplinary approach to the care of the surgical patient in order to obtain a rapid recovery after surgical intervention (11). While the initial efforts focused on colorectal surgery, the basic principles now been adopted to multiple surgical specialties (6,(12)(13)(14). ERAS protocols have been shown to be particularly bene cial for the elderly people who often have co-morbidities and run a higher risk of surgical complications.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

Wang

Kong

et al. 2020

Preprint

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Background: Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (>65 years old) with short-level lumbar fusion. Methods: A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. enhanced recovery after surgery interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores and 30-day readmission rates. Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs, Oswestry Disability Index score and readmission rates score revealed no significant differences between the groups at 30-day- follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30±3.03 of enhanced recovery after surgery group versus 15.50±1.88 in non- enhanced recovery after surgery group, p=0). Multivariable linear regression showed that comorbidities (p=0.023) and implementation of enhanced recovery after surgery program (p=0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. Conclusions: This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decreases length of stay in elderly patients with short-level lumbar fusion.

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Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery

Cited by 56 publications

References 34 publications

Recovery after enhanced versus conventional care laparoscopic hysterectomy performed in the afternoon: A randomized controlled trial

Recovery after enhanced versus conventional care laparoscopic hysterectomy performed in the afternoon: A randomized controlled trial

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

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